|
WAYNE PNEUMOTHORAX
|
Facility
|
OP
|
$587.00
|
|
| Hospital Charge Code |
4479109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.58 |
| Max. Negotiated Rate |
$472.54 |
| Rate for Payer: Aetna of NY Commercial |
$410.90
|
| Rate for Payer: Aetna of NY Medicare |
$270.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$440.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$440.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$217.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$293.50
|
| Rate for Payer: Cash Price |
$440.25
|
| Rate for Payer: CDPHP Commercial |
$472.54
|
| Rate for Payer: CDPHP Medicare |
$217.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$469.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$469.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$469.60
|
| Rate for Payer: EmblemHealth Medicaid |
$469.60
|
| Rate for Payer: EmblemHealth Medicare |
$199.58
|
| Rate for Payer: EmblemHealth Select Care |
$422.64
|
| Rate for Payer: Fidelis Medicare |
$223.71
|
| Rate for Payer: Galaxy Health Commercial |
$381.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$217.19
|
| Rate for Payer: Humana Medicare |
$217.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$410.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$270.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$440.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$330.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$228.05
|
| Rate for Payer: United Healthcare Medicare |
$217.19
|
| Rate for Payer: WellCare Medicare |
$322.85
|
|
|
WAYNE PNEUMOTHORAX
|
Facility
|
IP
|
$587.00
|
|
| Hospital Charge Code |
4479109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$381.55 |
| Max. Negotiated Rate |
$381.55 |
| Rate for Payer: Cash Price |
$440.25
|
| Rate for Payer: Galaxy Health Commercial |
$381.55
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4856705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.92 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$798.70
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$821.52
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$642.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4856705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4609572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
WEDGE EXC NAIL FOLD
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
4609572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
WEDGING OF CAST NOT CLUBFOOT CAST
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 29740
|
| Hospital Charge Code |
4850164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.88 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$537.60
|
| Rate for Payer: Aetna of NY Medicare |
$353.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$284.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$384.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: CDPHP Commercial |
$618.24
|
| Rate for Payer: CDPHP Medicare |
$284.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$614.40
|
| Rate for Payer: EmblemHealth Medicaid |
$614.40
|
| Rate for Payer: EmblemHealth Medicare |
$261.12
|
| Rate for Payer: EmblemHealth Select Care |
$552.96
|
| Rate for Payer: Fidelis Medicare |
$292.68
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.16
|
| Rate for Payer: Humana Medicare |
$284.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$537.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$353.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$432.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$255.88
|
| Rate for Payer: United Healthcare Medicare |
$284.16
|
| Rate for Payer: WellCare Medicare |
$422.40
|
|
|
WEDGING OF CAST NOT CLUBFOOT CAST
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 29740
|
| Hospital Charge Code |
4850164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
|
|
WEST NILE VIRUS AB IGM
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
4301197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Galaxy Health Commercial |
$176.80
|
|
|
WEST NILE VIRUS AB IGM
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
4301197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna of NY Commercial |
$176.80
|
| Rate for Payer: Aetna of NY Medicare |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$136.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: CDPHP Commercial |
$218.96
|
| Rate for Payer: CDPHP Medicare |
$100.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$163.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$217.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$217.60
|
| Rate for Payer: EmblemHealth Medicaid |
$217.60
|
| Rate for Payer: EmblemHealth Medicare |
$92.48
|
| Rate for Payer: EmblemHealth Select Care |
$163.20
|
| Rate for Payer: Fidelis Medicare |
$103.66
|
| Rate for Payer: Galaxy Health Commercial |
$176.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.64
|
| Rate for Payer: Humana Medicare |
$100.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$176.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$125.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$204.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$153.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$105.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$204.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$204.00
|
| Rate for Payer: United Healthcare Medicare |
$100.64
|
| Rate for Payer: WellCare Medicare |
$149.60
|
|
|
WET SKIN PREP TRAY
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4471379
|
|
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
|
|
|
WET SKIN PREP TRAY
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4471379
|
|
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
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
4650042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
4650042
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59
|
| Hospital Charge Code |
4650379
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59
|
| Hospital Charge Code |
4650379
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59,KX
|
| Hospital Charge Code |
4650431
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,59,KX
|
| Hospital Charge Code |
4650431
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,KX
|
| Hospital Charge Code |
4650324
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
WHEELCHAIR MNGMENT TRAINING EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97542 GP,KX
|
| Hospital Charge Code |
4650324
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
WHFO W/JOINT(S) CUSTOM FAB
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
HCPCS L3806
|
| Hospital Charge Code |
4690163
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.42 |
| Max. Negotiated Rate |
$1,016.72 |
| Rate for Payer: Aetna of NY Commercial |
$884.10
|
| Rate for Payer: Aetna of NY Medicare |
$580.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$568.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$568.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$467.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$631.50
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: CDPHP Commercial |
$1,016.72
|
| Rate for Payer: CDPHP Medicare |
$467.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$631.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,010.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicare |
$429.42
|
| Rate for Payer: EmblemHealth Select Care |
$631.50
|
| Rate for Payer: Fidelis Medicare |
$481.33
|
| Rate for Payer: Galaxy Health Commercial |
$820.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$467.31
|
| Rate for Payer: Humana Medicare |
$467.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$884.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$580.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$947.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$711.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$490.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$441.86
|
| Rate for Payer: United Healthcare Medicare |
$467.31
|
| Rate for Payer: WellCare Medicare |
$694.65
|
|
|
WHFO W/JOINT(S) CUSTOM FAB
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
HCPCS L3806
|
| Hospital Charge Code |
4690163
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$568.35 |
| Max. Negotiated Rate |
$820.95 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$568.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$568.35
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$631.50
|
| Rate for Payer: EmblemHealth Select Care |
$631.50
|
| Rate for Payer: Galaxy Health Commercial |
$820.95
|
| Rate for Payer: Multiplan Commercial |
$568.35
|
| Rate for Payer: WellCare Medicare |
$694.65
|
|
|
WHFO W/O JOINTS PRE CST
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
4690167
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.65 |
| Max. Negotiated Rate |
$453.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$313.65
|
| Rate for Payer: Cash Price |
$522.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$348.50
|
| Rate for Payer: EmblemHealth Select Care |
$348.50
|
| Rate for Payer: Galaxy Health Commercial |
$453.05
|
| Rate for Payer: Multiplan Commercial |
$313.65
|
| Rate for Payer: WellCare Medicare |
$383.35
|
|
|
WHFO W/O JOINTS PRE CST
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
4690167
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$236.98 |
| Max. Negotiated Rate |
$561.08 |
| Rate for Payer: Aetna of NY Commercial |
$487.90
|
| Rate for Payer: Aetna of NY Medicare |
$320.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$257.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$348.50
|
| Rate for Payer: Cash Price |
$522.75
|
| Rate for Payer: Cash Price |
$522.75
|
| Rate for Payer: CDPHP Commercial |
$561.08
|
| Rate for Payer: CDPHP Medicare |
$257.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$348.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$557.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$557.60
|
| Rate for Payer: EmblemHealth Medicaid |
$557.60
|
| Rate for Payer: EmblemHealth Medicare |
$236.98
|
| Rate for Payer: EmblemHealth Select Care |
$348.50
|
| Rate for Payer: Fidelis Medicare |
$265.63
|
| Rate for Payer: Galaxy Health Commercial |
$453.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$257.89
|
| Rate for Payer: Humana Medicare |
$257.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$487.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$320.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$522.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$392.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$270.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$243.40
|
| Rate for Payer: United Healthcare Medicare |
$257.89
|
| Rate for Payer: WellCare Medicare |
$383.35
|
|
|
WHIRLPOOL THERAPY
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GP
|
| Hospital Charge Code |
4650043
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Commercial |
$51.52
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$51.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$51.20
|
| Rate for Payer: EmblemHealth Medicaid |
$51.20
|
| Rate for Payer: EmblemHealth Medicare |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$46.08
|
| Rate for Payer: Fidelis Medicare |
$24.39
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.68
|
| Rate for Payer: Humana Medicare |
$23.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| 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 |
$24.86
|
| 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 |
$23.68
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
