|
WORK HARDENING EA ADDTL 1.00 HR (W/ KX)
|
Facility
|
IP
|
$73.13
|
|
|
Service Code
|
HCPCS 97546 GP,KX
|
| Hospital Charge Code |
4650336
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: Galaxy Health Commercial |
$47.53
|
|
|
WORK HARDENING INIT 2 HRS
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP
|
| Hospital Charge Code |
4650044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
WORK HARDENING INIT 2 HRS
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP
|
| Hospital Charge Code |
4650044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59)
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP,59
|
| Hospital Charge Code |
4650381
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59)
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP,59
|
| Hospital Charge Code |
4650381
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59 W KX)
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP,59,KX
|
| Hospital Charge Code |
4650433
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
WORK HARDENING INIT 2 HRS (MOD 59 W KX)
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP,59,KX
|
| Hospital Charge Code |
4650433
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
WORK HARDENING INIT 2 HRS (W/ KX)
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP,KX
|
| Hospital Charge Code |
4650326
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
WORK HARDENING INIT 2 HRS (W/ KX)
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GP,KX
|
| Hospital Charge Code |
4650326
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
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
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GP
|
| Hospital Charge Code |
4650045
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| 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 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 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
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 |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| 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 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 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| 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
|
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 (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 |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| 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 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 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
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 |
$17.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.00
|
| 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 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 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$46.00
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.00
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$48.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$46.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| 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
|
$1,174.20
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
4690158
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$939.36 |
| Rate for Payer: Aetna of NY Commercial |
$821.94
|
| Rate for Payer: Aetna of NY Medicare |
$540.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$469.68
|
| Rate for Payer: Cash Price |
$880.65
|
| Rate for Payer: CDPHP Medicare |
$434.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$587.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$939.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$939.36
|
| Rate for Payer: EmblemHealth Medicaid |
$939.36
|
| Rate for Payer: EmblemHealth Medicare |
$399.23
|
| Rate for Payer: EmblemHealth Select Care |
$587.10
|
| Rate for Payer: Fidelis Medicare |
$469.68
|
| Rate for Payer: Galaxy Health Commercial |
$763.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$469.68
|
| Rate for Payer: Humana Medicare |
$469.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$821.94
|
| Rate for Payer: Local 1199SEIU Medicare |
$540.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$880.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$661.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$493.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$176.13
|
| Rate for Payer: United Healthcare Medicare |
$469.68
|
| Rate for Payer: WellCare Medicare |
$645.81
|
|
|
WRIST-HAND-FINGER ORTHOTIC (WHFO), RIGID WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE MATERIAL; STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT
|
Facility
|
IP
|
$1,174.20
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
4690158
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$528.39 |
| Max. Negotiated Rate |
$763.23 |
| Rate for Payer: Cash Price |
$880.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$587.10
|
| Rate for Payer: EmblemHealth Select Care |
$587.10
|
| Rate for Payer: Galaxy Health Commercial |
$763.23
|
| Rate for Payer: Multiplan Commercial |
$528.39
|
| Rate for Payer: WellCare Medicare |
$645.81
|
|
|
WRIST-HAND ORTHOTIC (WHO), WITHOUT JOINTS
|
Facility
|
IP
|
$1,200.98
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
4690161
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$540.44 |
| Max. Negotiated Rate |
$780.64 |
| Rate for Payer: Cash Price |
$900.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$600.49
|
| Rate for Payer: EmblemHealth Select Care |
$600.49
|
| Rate for Payer: Galaxy Health Commercial |
$780.64
|
| Rate for Payer: Multiplan Commercial |
$540.44
|
| Rate for Payer: WellCare Medicare |
$660.54
|
|
|
WRIST-HAND ORTHOTIC (WHO), WITHOUT JOINTS
|
Facility
|
OP
|
$1,200.98
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
4690161
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.15 |
| Max. Negotiated Rate |
$960.78 |
| Rate for Payer: Aetna of NY Commercial |
$840.69
|
| Rate for Payer: Aetna of NY Medicare |
$552.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$480.39
|
| Rate for Payer: Cash Price |
$900.74
|
| Rate for Payer: CDPHP Medicare |
$444.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$600.49
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$960.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$960.78
|
| Rate for Payer: EmblemHealth Medicaid |
$960.78
|
| Rate for Payer: EmblemHealth Medicare |
$408.33
|
| Rate for Payer: EmblemHealth Select Care |
$600.49
|
| Rate for Payer: Fidelis Medicare |
$480.39
|
| Rate for Payer: Galaxy Health Commercial |
$780.64
|
| Rate for Payer: Hamaspik Choice Medicare |
$480.39
|
| Rate for Payer: Humana Medicare |
$480.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$840.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$552.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$900.74
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$676.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$504.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$180.15
|
| Rate for Payer: United Healthcare Medicare |
$480.39
|
| Rate for Payer: WellCare Medicare |
$660.54
|
|
|
XARELTO 10MG
|
Facility
|
OP
|
$44.55
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
4409059
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$35.64 |
| 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) Medicare |
$17.82
|
| Rate for Payer: Cash Price |
$33.41
|
| 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 |
$17.82
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.82
|
| Rate for Payer: Humana Medicare |
$17.82
|
| 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 |
$18.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.68
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
|
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 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 |
$8.00 |
| Max. Negotiated Rate |
$42.66 |
| 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) Medicare |
$21.33
|
| Rate for Payer: Cash Price |
$39.99
|
| 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 |
$21.33
|
| Rate for Payer: Galaxy Health Commercial |
$34.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.33
|
| Rate for Payer: Humana Medicare |
$21.33
|
| 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 |
$22.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.00
|
| Rate for Payer: United Healthcare Medicare |
$21.33
|
| Rate for Payer: WellCare Medicare |
$29.33
|
|
