|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$32,731.96
|
|
|
Service Code
|
MSDRG 152
|
| Min. Negotiated Rate |
$10,188.80 |
| Max. Negotiated Rate |
$32,731.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,520.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,805.06
|
| Rate for Payer: Aetna Government |
$23,805.06
|
| Rate for Payer: Brighton Health Commercial |
$17,228.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,281.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,519.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,933.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,614.81
|
| Rate for Payer: EmblemHealth Commercial |
$10,188.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,805.06
|
| Rate for Payer: Group Health Inc Commercial |
$23,805.06
|
| Rate for Payer: Group Health Inc Medicare |
$23,805.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,805.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,069.35
|
| Rate for Payer: Humana Medicare |
$32,731.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,805.06
|
| Rate for Payer: United Healthcare Commercial |
$23,629.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,805.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,805.06
|
| Rate for Payer: Wellcare Medicare |
$22,614.81
|
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$24,086.71
|
|
|
Service Code
|
MSDRG 153
|
| Min. Negotiated Rate |
$6,300.91 |
| Max. Negotiated Rate |
$24,086.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,834.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,517.61
|
| Rate for Payer: Aetna Government |
$17,517.61
|
| Rate for Payer: Brighton Health Commercial |
$10,654.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,867.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,689.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,471.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,641.73
|
| Rate for Payer: EmblemHealth Commercial |
$6,300.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,517.61
|
| Rate for Payer: Group Health Inc Commercial |
$17,517.61
|
| Rate for Payer: Group Health Inc Medicare |
$17,517.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,517.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,145.69
|
| Rate for Payer: Humana Medicare |
$24,086.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,517.61
|
| Rate for Payer: United Healthcare Commercial |
$14,612.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,517.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,517.61
|
| Rate for Payer: Wellcare Medicare |
$16,641.73
|
|
|
OT KLEINERT'S TRACTION
|
Facility
|
OP
|
$326.03
|
|
|
Service Code
|
HCPCS L3931
|
| Hospital Charge Code |
41809260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.61 |
| Max. Negotiated Rate |
$342.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.61
|
| Rate for Payer: Aetna Government |
$91.61
|
| Rate for Payer: Brighton Health Commercial |
$195.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$163.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.47
|
| Rate for Payer: EmblemHealth Commercial |
$163.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.33
|
| Rate for Payer: Group Health Inc Commercial |
$163.02
|
| Rate for Payer: Group Health Inc Medicare |
$114.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.92
|
|
|
OT KNUCLE BENDER
|
Facility
|
OP
|
$40.75
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
41808092
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$42.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.50
|
| Rate for Payer: Aetna Government |
$37.50
|
| Rate for Payer: Brighton Health Commercial |
$24.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.43
|
| Rate for Payer: EmblemHealth Commercial |
$20.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.79
|
| Rate for Payer: Group Health Inc Commercial |
$20.38
|
| Rate for Payer: Group Health Inc Medicare |
$14.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.49
|
|
|
OT LEG LIFTER
|
Facility
|
OP
|
$9.80
|
|
| Hospital Charge Code |
41809538
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.90
|
| Rate for Payer: Aetna Government |
$4.90
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$4.90
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT LIPPED PLATE
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
HCPCS 99070
|
| Hospital Charge Code |
41809521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$11.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.26
|
| Rate for Payer: Aetna Government |
$10.26
|
| Rate for Payer: Brighton Health Commercial |
$10.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.64
|
| Rate for Payer: Group Health Inc Commercial |
$7.09
|
| Rate for Payer: Group Health Inc Medicare |
$4.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.09
|
|
|
OT LONG HANDLE SPONGE
|
Facility
|
OP
|
$7.78
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809533
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$5.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.29
|
| Rate for Payer: Group Health Inc Commercial |
$3.89
|
| Rate for Payer: Group Health Inc Medicare |
$2.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.89
|
|
|
OTM ADL TRAINING 15 MTS
|
Facility
|
OP
|
$99.85
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
41804499
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$5,078.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.18
|
| Rate for Payer: Aetna Government |
$21.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$114.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$114.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.78
|
| Rate for Payer: Amida Care Medicaid |
$50.78
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,078.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.32
|
| Rate for Payer: Group Health Inc Commercial |
$49.92
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.78
|
| Rate for Payer: Healthfirst Essential Plan |
$114.26
|
| Rate for Payer: Healthfirst QHP |
$50.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.78
|
| Rate for Payer: SOMOS Essential |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$114.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55.86
|
| Rate for Payer: United Healthcare Medicaid |
$50.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.78
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OTM ANGELED FORK/SPOON
|
Facility
|
OP
|
$34.02
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804526
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$27.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$25.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.01
|
| Rate for Payer: Group Health Inc Medicare |
$11.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.01
|
|
|
OTM ANGELED KNIFE
|
Facility
|
OP
|
$20.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804527
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$15.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.98
|
| Rate for Payer: Group Health Inc Commercial |
$10.28
|
| Rate for Payer: Group Health Inc Medicare |
$7.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.28
|
|
|
OT MANUAL THERAPY TECHNIQUES 15MT
|
Facility
|
OP
|
$81.83
|
|
|
Service Code
|
HCPCS 97140 GO
|
| Hospital Charge Code |
41809494
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.78
|
| Rate for Payer: Aetna Government |
$17.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.88
|
| Rate for Payer: Amida Care Medicaid |
$47.88
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,788.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.27
|
| Rate for Payer: Group Health Inc Commercial |
$40.92
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Healthfirst Essential Plan |
$107.73
|
| Rate for Payer: Healthfirst QHP |
$47.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.88
|
| Rate for Payer: SOMOS Essential |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$107.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52.67
|
| Rate for Payer: United Healthcare Medicaid |
$47.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OTM BIOFEEDBACK TRG BY ANY MODALI
|
Facility
|
OP
|
$57.33
|
|
|
Service Code
|
HCPCS 90901 GP
|
| Hospital Charge Code |
41804514
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.30
|
| Rate for Payer: Aetna Government |
$96.30
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$28.66
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.66
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OTM BOUTONNIERE DEFORM STAT SPLIN
|
Facility
|
OP
|
$122.26
|
|
|
Service Code
|
HCPCS Q4049
|
| Hospital Charge Code |
41804350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$97.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.84
|
| Rate for Payer: Aetna Government |
$1.84
|
| Rate for Payer: Brighton Health Commercial |
$91.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.14
|
| Rate for Payer: Group Health Inc Commercial |
$61.13
|
| Rate for Payer: Group Health Inc Medicare |
$42.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.13
|
|
|
OTM BUDDY STRAP
|
Facility
|
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
41804402
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OTM BUDDY STRAP
|
Facility
|
IP
|
$101.25
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
41804402
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
OTM COCK UP SPLINT
|
Facility
|
OP
|
$244.52
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
41804150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$256.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.32
|
| Rate for Payer: Aetna Government |
$38.32
|
| Rate for Payer: Brighton Health Commercial |
$146.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.60
|
| Rate for Payer: EmblemHealth Commercial |
$122.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$256.75
|
| Rate for Payer: Group Health Inc Commercial |
$122.26
|
| Rate for Payer: Group Health Inc Medicare |
$85.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.94
|
|
|
OTM CONTRAST BATH 15 MTS
|
Facility
|
OP
|
$44.20
|
|
|
Service Code
|
HCPCS 97034 GO
|
| Hospital Charge Code |
41804480
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.95
|
| Rate for Payer: Aetna Government |
$10.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$65.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$65.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.02
|
| Rate for Payer: Amida Care Medicaid |
$29.02
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,902.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.47
|
| Rate for Payer: Group Health Inc Commercial |
$22.10
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Healthfirst Essential Plan |
$65.30
|
| Rate for Payer: Healthfirst QHP |
$29.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.02
|
| Rate for Payer: SOMOS Essential |
$65.30
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$65.30
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$31.92
|
| Rate for Payer: United Healthcare Medicaid |
$29.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OTM DORSAL HOOD-DYNAMIC TRACT SPL
|
Facility
|
OP
|
$244.52
|
|
|
Service Code
|
HCPCS E1805
|
| Hospital Charge Code |
41804700
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.58 |
| Max. Negotiated Rate |
$955.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$955.30
|
| Rate for Payer: Aetna Government |
$955.30
|
| Rate for Payer: Brighton Health Commercial |
$183.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.27
|
| Rate for Payer: Group Health Inc Commercial |
$122.26
|
| Rate for Payer: Group Health Inc Medicare |
$85.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.26
|
|
|
OTM DORSAL HOOD - ELBOW BASED
|
Facility
|
OP
|
$489.04
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
41804800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.16 |
| Max. Negotiated Rate |
$513.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.89
|
| Rate for Payer: Aetna Government |
$195.89
|
| Rate for Payer: Brighton Health Commercial |
$293.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$244.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$281.20
|
| Rate for Payer: EmblemHealth Commercial |
$244.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$513.49
|
| Rate for Payer: Group Health Inc Commercial |
$244.52
|
| Rate for Payer: Group Health Inc Medicare |
$171.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$317.88
|
|
|
OTM DORSAL HOOD - FOREARM
|
Facility
|
OP
|
$326.03
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
41804750
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$342.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.89
|
| Rate for Payer: Aetna Government |
$195.89
|
| Rate for Payer: Brighton Health Commercial |
$195.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$163.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.47
|
| Rate for Payer: EmblemHealth Commercial |
$163.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.33
|
| Rate for Payer: Group Health Inc Commercial |
$163.02
|
| Rate for Payer: Group Health Inc Medicare |
$114.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.92
|
|
|
OTM DORSAL WRIST & OUTRIGGER
|
Facility
|
OP
|
$326.03
|
|
|
Service Code
|
HCPCS L3931
|
| Hospital Charge Code |
41804091
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.61 |
| Max. Negotiated Rate |
$342.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.61
|
| Rate for Payer: Aetna Government |
$91.61
|
| Rate for Payer: Brighton Health Commercial |
$195.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$163.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.47
|
| Rate for Payer: EmblemHealth Commercial |
$163.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.33
|
| Rate for Payer: Group Health Inc Commercial |
$163.02
|
| Rate for Payer: Group Health Inc Medicare |
$114.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.92
|
|
|
OTM DRESSING STICK
|
Facility
|
OP
|
$8.51
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804531
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$6.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
|
|
OTM DYNAMIC WRIST EXTENSION
|
Facility
|
OP
|
$260.82
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
41804280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.29 |
| Max. Negotiated Rate |
$620.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$620.77
|
| Rate for Payer: Aetna Government |
$620.77
|
| Rate for Payer: Brighton Health Commercial |
$156.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.97
|
| Rate for Payer: EmblemHealth Commercial |
$130.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.86
|
| Rate for Payer: Group Health Inc Commercial |
$130.41
|
| Rate for Payer: Group Health Inc Medicare |
$91.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.53
|
|
|
OTM ELASTIC SHOE LACES
|
Facility
|
OP
|
$7.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804535
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$5.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Medicare |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.54
|
|
|
OTM ELASTIC WRIST SUPPORT
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
41804900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$51.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.50
|
| Rate for Payer: Aetna Government |
$37.50
|
| Rate for Payer: Brighton Health Commercial |
$29.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$24.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.36
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
