|
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
|
|
|
WHIRLPOOL THERAPY (MOD 59)
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GP,59
|
| Hospital Charge Code |
4650380
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
WHIRLPOOL THERAPY (MOD 59)
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GP,59
|
| Hospital Charge Code |
4650380
|
|
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
|
|
|
WHIRLPOOL THERAPY (MOD 59 W KX)
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GP,59,KX
|
| Hospital Charge Code |
4650432
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
WHIRLPOOL THERAPY (MOD 59 W KX)
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GP,59,KX
|
| Hospital Charge Code |
4650432
|
|
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
|
|
|
WHIRLPOOL THERAPY (W/ KX)
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GP,KX
|
| Hospital Charge Code |
4650325
|
|
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
|
|
|
WHIRLPOOL THERAPY (W/ KX)
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GP,KX
|
| Hospital Charge Code |
4650325
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
WHO W/NONTORSION JNT(S) CF
|
Facility
|
IP
|
$2,753.00
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
4690164
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,238.85 |
| Max. Negotiated Rate |
$1,789.45 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,238.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,238.85
|
| Rate for Payer: Cash Price |
$2,064.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,376.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,376.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,789.45
|
| Rate for Payer: Multiplan Commercial |
$1,238.85
|
| Rate for Payer: WellCare Medicare |
$1,514.15
|
|
|
WHO W/NONTORSION JNT(S) CF
|
Facility
|
OP
|
$2,753.00
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
4690164
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$936.02 |
| Max. Negotiated Rate |
$2,216.16 |
| Rate for Payer: Aetna of NY Commercial |
$1,927.10
|
| Rate for Payer: Aetna of NY Medicare |
$1,266.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,238.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,238.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,018.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,376.50
|
| Rate for Payer: Cash Price |
$2,064.75
|
| Rate for Payer: Cash Price |
$2,064.75
|
| Rate for Payer: CDPHP Commercial |
$2,216.16
|
| Rate for Payer: CDPHP Medicare |
$1,018.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,376.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,202.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,202.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,202.40
|
| Rate for Payer: EmblemHealth Medicare |
$936.02
|
| Rate for Payer: EmblemHealth Select Care |
$1,376.50
|
| Rate for Payer: Fidelis Medicare |
$1,049.17
|
| Rate for Payer: Galaxy Health Commercial |
$1,789.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,018.61
|
| Rate for Payer: Humana Medicare |
$1,018.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,927.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,266.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,064.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,549.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,069.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$964.63
|
| Rate for Payer: United Healthcare Medicare |
$1,018.61
|
| Rate for Payer: WellCare Medicare |
$1,514.15
|
|
|
WINDOWING OF CAST
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29730
|
| Hospital Charge Code |
4850165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$315.70
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| 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 |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| 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 |
$315.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
WINDOWING OF CAST
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29730
|
| Hospital Charge Code |
4850165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
|
|
WIXELA 100-50 INHUB 100 mcg, 60 eaches
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
4401532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Aetna of NY Commercial |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$486.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Galaxy Health Commercial |
$702.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$594.00
|
| Rate for Payer: WellCare Medicare |
$594.00
|
|
|
WIXELA 100-50 INHUB 100 mcg, 60 eaches
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
4401532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna of NY Commercial |
$594.00
|
| Rate for Payer: Aetna of NY Medicare |
$496.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$399.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$540.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: CDPHP Commercial |
$869.40
|
| Rate for Payer: CDPHP Medicare |
$399.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$864.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$864.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$864.00
|
| Rate for Payer: EmblemHealth Medicaid |
$864.00
|
| Rate for Payer: EmblemHealth Medicare |
$367.20
|
| Rate for Payer: EmblemHealth Select Care |
$777.60
|
| Rate for Payer: Fidelis Medicare |
$411.59
|
| Rate for Payer: Galaxy Health Commercial |
$702.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$399.60
|
| Rate for Payer: Humana Medicare |
$399.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$594.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$496.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$810.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$608.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$419.58
|
| Rate for Payer: United Healthcare Medicare |
$399.60
|
| Rate for Payer: WellCare Medicare |
$594.00
|
|
|
WIXELA 250-50 INHUB 250 mcg, 60 eaches
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
NDC 00378932132
|
| Hospital Charge Code |
4401539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
WIXELA 250-50 INHUB 250 mcg, 60 eaches
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 00378932132
|
| Hospital Charge Code |
4401539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
WIXELA 500-50 INHUB 500 mcg, 60 eaches
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
NDC 00378932232
|
| Hospital Charge Code |
4401944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$603.50 |
| Max. Negotiated Rate |
$1,428.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,242.50
|
| Rate for Payer: Aetna of NY Medicare |
$816.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,331.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,331.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$656.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$887.50
|
| Rate for Payer: Cash Price |
$1,331.25
|
| Rate for Payer: CDPHP Commercial |
$1,428.88
|
| Rate for Payer: CDPHP Medicare |
$656.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,420.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,420.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,420.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,420.00
|
| Rate for Payer: EmblemHealth Medicare |
$603.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,278.00
|
| Rate for Payer: Fidelis Medicare |
$676.45
|
| Rate for Payer: Galaxy Health Commercial |
$1,153.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$656.75
|
| Rate for Payer: Humana Medicare |
$656.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,242.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$816.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,331.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$999.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$689.59
|
| Rate for Payer: United Healthcare Medicare |
$656.75
|
| Rate for Payer: WellCare Medicare |
$976.25
|
|
|
WIXELA 500-50 INHUB 500 mcg, 60 eaches
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
NDC 00378932232
|
| Hospital Charge Code |
4401944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$976.25 |
| Max. Negotiated Rate |
$1,153.75 |
| Rate for Payer: Cash Price |
$1,331.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,153.75
|
| Rate for Payer: WellCare Medicare |
$976.25
|
|
|
WORK HARDENING EA ADDTL 1.00 HR
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP
|
| Hospital Charge Code |
4650067
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
WORK HARDENING EA ADDTL 1.00 HR
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP
|
| Hospital Charge Code |
4650067
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
WORK HARDENING EA ADDTL 1.00 HR (MOD 59)
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP,59
|
| Hospital Charge Code |
4650388
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
WORK HARDENING EA ADDTL 1.00 HR (MOD 59)
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP,59
|
| Hospital Charge Code |
4650388
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
WORK HARDENING EA ADDTL 1.00 HR (MOD 59 W KX)
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP,59,KX
|
| Hospital Charge Code |
4650440
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
WORK HARDENING EA ADDTL 1.00 HR (MOD 59 W KX)
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP,59,KX
|
| Hospital Charge Code |
4650440
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
WORK HARDENING EA ADDTL 1.00 HR (W/ KX)
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP,KX
|
| Hospital Charge Code |
4650336
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
WORK HARDENING EA ADDTL 1.00 HR (W/ KX)
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97546 GP,KX
|
| Hospital Charge Code |
4650336
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
