|
WORK HARDENING INIT 2 HRS
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP
|
| Hospital Charge Code |
4650044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Commercial |
$109.48
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
| Rate for Payer: EmblemHealth Medicaid |
$108.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$51.83
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
| Rate for Payer: Humana Medicare |
$50.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| 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 |
$52.84
|
| 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 |
$50.32
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
WORK HARDENING INIT 2 HRS
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP
|
| Hospital Charge Code |
4650044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP,59
|
| Hospital Charge Code |
4650381
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP,59
|
| Hospital Charge Code |
4650381
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Commercial |
$109.48
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
| Rate for Payer: EmblemHealth Medicaid |
$108.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$51.83
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
| Rate for Payer: Humana Medicare |
$50.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| 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 |
$52.84
|
| 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 |
$50.32
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59 W KX)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP,59,KX
|
| Hospital Charge Code |
4650433
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59 W KX)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP,59,KX
|
| Hospital Charge Code |
4650433
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Commercial |
$109.48
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
| Rate for Payer: EmblemHealth Medicaid |
$108.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$51.83
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
| Rate for Payer: Humana Medicare |
$50.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| 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 |
$52.84
|
| 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 |
$50.32
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
WORK HARDENING INIT 2 HRS (W/ KX)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP,KX
|
| Hospital Charge Code |
4650326
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Commercial |
$109.48
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
| Rate for Payer: EmblemHealth Medicaid |
$108.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$51.83
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
| Rate for Payer: Humana Medicare |
$50.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| 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 |
$52.84
|
| 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 |
$50.32
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
WORK HARDENING INIT 2 HRS (W/ KX)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97545 GP,KX
|
| Hospital Charge Code |
4650326
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
WORK TASK ANALYSIS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP
|
| Hospital Charge Code |
4650045
|
|
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
|
|
|
WORK TASK ANALYSIS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP
|
| Hospital Charge Code |
4650045
|
|
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
|
|
|
WORK TASK ANALYSIS (MOD 59)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP,59
|
| Hospital Charge Code |
4650382
|
|
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
|
|
|
WORK TASK ANALYSIS (MOD 59)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP,59
|
| Hospital Charge Code |
4650382
|
|
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
|
|
|
WORK TASK ANALYSIS (MOD 59 W KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP,59,KX
|
| Hospital Charge Code |
4650434
|
|
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
|
|
|
WORK TASK ANALYSIS (MOD 59 W KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP,59,KX
|
| Hospital Charge Code |
4650434
|
|
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
|
|
|
WORK TASK ANALYSIS (W/ KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP,KX
|
| Hospital Charge Code |
4650327
|
|
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
|
|
|
WORK TASK ANALYSIS (W/ KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP,KX
|
| Hospital Charge Code |
4650327
|
|
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
|
|
|
WRIST-HAND-FINGER ORTHOTIC (WHFO), RIGID WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE MATERIAL; STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
4690158
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$362.61 |
| Max. Negotiated Rate |
$917.70 |
| Rate for Payer: Aetna of NY Commercial |
$798.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$421.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: CDPHP Commercial |
$917.70
|
| Rate for Payer: CDPHP Medicare |
$421.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$570.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.00
|
| Rate for Payer: EmblemHealth Medicaid |
$912.00
|
| Rate for Payer: EmblemHealth Medicare |
$387.60
|
| Rate for Payer: EmblemHealth Select Care |
$570.00
|
| Rate for Payer: Fidelis Medicare |
$434.45
|
| Rate for Payer: Galaxy Health Commercial |
$741.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$421.80
|
| Rate for Payer: Humana Medicare |
$421.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$798.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$855.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$641.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$442.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$362.61
|
| Rate for Payer: United Healthcare Medicare |
$421.80
|
| Rate for Payer: WellCare Medicare |
$627.00
|
|
|
WRIST-HAND-FINGER ORTHOTIC (WHFO), RIGID WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE MATERIAL; STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
4690158
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$513.00 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$513.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$570.00
|
| Rate for Payer: EmblemHealth Select Care |
$570.00
|
| Rate for Payer: Galaxy Health Commercial |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: WellCare Medicare |
$627.00
|
|
|
WRIST-HAND ORTHOTIC (WHO), WITHOUT JOINTS
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
4690161
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$396.44 |
| Max. Negotiated Rate |
$938.63 |
| Rate for Payer: Aetna of NY Commercial |
$816.20
|
| Rate for Payer: Aetna of NY Medicare |
$536.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$524.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$524.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$431.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$583.00
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: CDPHP Commercial |
$938.63
|
| Rate for Payer: CDPHP Medicare |
$431.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$583.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$932.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$932.80
|
| Rate for Payer: EmblemHealth Medicaid |
$932.80
|
| Rate for Payer: EmblemHealth Medicare |
$396.44
|
| Rate for Payer: EmblemHealth Select Care |
$583.00
|
| Rate for Payer: Fidelis Medicare |
$444.36
|
| Rate for Payer: Galaxy Health Commercial |
$757.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$431.42
|
| Rate for Payer: Humana Medicare |
$431.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$816.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$536.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$874.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$656.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$452.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$432.53
|
| Rate for Payer: United Healthcare Medicare |
$431.42
|
| Rate for Payer: WellCare Medicare |
$641.30
|
|
|
WRIST-HAND ORTHOTIC (WHO), WITHOUT JOINTS
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
4690161
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$524.70 |
| Max. Negotiated Rate |
$757.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$524.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$524.70
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$583.00
|
| Rate for Payer: EmblemHealth Select Care |
$583.00
|
| Rate for Payer: Galaxy Health Commercial |
$757.90
|
| Rate for Payer: Multiplan Commercial |
$524.70
|
| Rate for Payer: WellCare Medicare |
$641.30
|
|
|
XARELTO 10MG
|
Facility
|
IP
|
$44.55
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
4409059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
|
XARELTO 10MG
|
Facility
|
OP
|
$44.55
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
4409059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna of NY Commercial |
$31.18
|
| Rate for Payer: Aetna of NY Medicare |
$20.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.28
|
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: CDPHP Commercial |
$35.86
|
| Rate for Payer: CDPHP Medicare |
$16.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.64
|
| Rate for Payer: EmblemHealth Medicaid |
$35.64
|
| Rate for Payer: EmblemHealth Medicare |
$15.15
|
| Rate for Payer: EmblemHealth Select Care |
$32.08
|
| Rate for Payer: Fidelis Medicare |
$16.98
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.48
|
| Rate for Payer: Humana Medicare |
$16.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.31
|
| Rate for Payer: United Healthcare Medicare |
$16.48
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
|
XARELTO 15 MG TAB
|
Facility
|
IP
|
$53.32
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
4409127
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.33 |
| Max. Negotiated Rate |
$34.66 |
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Galaxy Health Commercial |
$34.66
|
| Rate for Payer: WellCare Medicare |
$29.33
|
|
|
XARELTO 15 MG TAB
|
Facility
|
OP
|
$53.32
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
4409127
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$42.92 |
| Rate for Payer: Aetna of NY Commercial |
$37.32
|
| Rate for Payer: Aetna of NY Medicare |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.66
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: CDPHP Commercial |
$42.92
|
| Rate for Payer: CDPHP Medicare |
$19.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$42.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.66
|
| Rate for Payer: EmblemHealth Medicaid |
$42.66
|
| Rate for Payer: EmblemHealth Medicare |
$18.13
|
| Rate for Payer: EmblemHealth Select Care |
$38.39
|
| Rate for Payer: Fidelis Medicare |
$20.32
|
| Rate for Payer: Galaxy Health Commercial |
$34.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.73
|
| Rate for Payer: Humana Medicare |
$19.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.32
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.99
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.71
|
| Rate for Payer: United Healthcare Medicare |
$19.73
|
| Rate for Payer: WellCare Medicare |
$29.33
|
|
|
XARELTO 20 MG TABLET
|
Facility
|
OP
|
$44.55
|
|
|
Service Code
|
NDC 50458057910
|
| Hospital Charge Code |
4409128
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna of NY Commercial |
$31.18
|
| Rate for Payer: Aetna of NY Medicare |
$20.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.28
|
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: CDPHP Commercial |
$35.86
|
| Rate for Payer: CDPHP Medicare |
$16.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.64
|
| Rate for Payer: EmblemHealth Medicaid |
$35.64
|
| Rate for Payer: EmblemHealth Medicare |
$15.15
|
| Rate for Payer: EmblemHealth Select Care |
$32.08
|
| Rate for Payer: Fidelis Medicare |
$16.98
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.48
|
| Rate for Payer: Humana Medicare |
$16.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.31
|
| Rate for Payer: United Healthcare Medicare |
$16.48
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
