|
APPLICATION SHORT LEG SPLINT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4600018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPLICATION SPLINT- LONG ARM
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4650062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
APPLICATION SPLINT- LONG ARM
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4650062
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPLICATION SPLINT- SHORT LEG
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4650065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
APPLICATION SPLINT- SHORT LEG
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
4650065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPLICATION STATIC SPLINT- SHORT ARM
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126 GP
|
| Hospital Charge Code |
4650063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
APPLICATION STATIC SPLINT- SHORT ARM
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126 GP
|
| Hospital Charge Code |
4650063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
APPLICATOR SEPP CHLORAPREP 0.
|
Facility
|
IP
|
$1.03
|
|
| Hospital Charge Code |
4471725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Galaxy Health Commercial |
$0.67
|
|
|
APPLICATOR SEPP CHLORAPREP 0.
|
Facility
|
OP
|
$1.03
|
|
| Hospital Charge Code |
4471725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of NY Commercial |
$0.72
|
| Rate for Payer: Aetna of NY Medicare |
$0.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.41
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: CDPHP Medicare |
$0.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.82
|
| Rate for Payer: EmblemHealth Medicaid |
$0.82
|
| Rate for Payer: EmblemHealth Medicare |
$0.35
|
| Rate for Payer: EmblemHealth Select Care |
$0.74
|
| Rate for Payer: Fidelis Medicare |
$0.41
|
| Rate for Payer: Galaxy Health Commercial |
$0.67
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.41
|
| Rate for Payer: Humana Medicare |
$0.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.72
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.41
|
| Rate for Payer: WellCare Medicare |
$0.57
|
|
|
APPLIC-SHORT ARM SPLINT DYNAM
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
4600014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
APPLIC-SHORT ARM SPLINT DYNAM
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
4600014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
APPL MULTLAY COMPRS ARM/HAND
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29584
|
| Hospital Charge Code |
4851986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPL MULTLAY COMPRS ARM/HAND
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29584
|
| Hospital Charge Code |
4851986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
APPLY CLUBFOOT CAST LONG OR SHORT LEG
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
4850019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPLY CLUBFOOT CAST LONG OR SHORT LEG
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
4850019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
APPLY FINGER CAST
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29086 TC
|
| Hospital Charge Code |
4850126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
APPLY FINGER CAST
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29086 TC
|
| Hospital Charge Code |
4850126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPLY FINGER SPLINT; STATIC
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
4650064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
APPLY FINGER SPLINT; STATIC
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
4650064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
APPLY MULTILAYER COMPRESS - LOWER LEG
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29581 GP
|
| Hospital Charge Code |
4650283
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
APPLY MULTILAYER COMPRESS - LOWER LEG
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29581 GP
|
| Hospital Charge Code |
4650283
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4851926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
APPLY MULTLAY COMPRS LWR LEG
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29581
|
| Hospital Charge Code |
4851926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
APPLY SH LEG CAST
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
4856677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.55 |
| Max. Negotiated Rate |
$685.60 |
| Rate for Payer: Aetna of NY Commercial |
$599.90
|
| Rate for Payer: Aetna of NY Medicare |
$394.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$342.80
|
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: CDPHP Medicare |
$317.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$685.60
|
| Rate for Payer: EmblemHealth Medicaid |
$685.60
|
| Rate for Payer: EmblemHealth Medicare |
$291.38
|
| Rate for Payer: EmblemHealth Select Care |
$617.04
|
| Rate for Payer: Fidelis Medicare |
$342.80
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$342.80
|
| Rate for Payer: Humana Medicare |
$342.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$599.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$394.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$642.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$482.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$359.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$128.55
|
| Rate for Payer: United Healthcare Medicare |
$342.80
|
| Rate for Payer: WellCare Medicare |
$471.35
|
|
|
APPLY SH LEG CAST
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
4856677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.05 |
| Max. Negotiated Rate |
$557.05 |
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
|
