|
PTA 2.5X16
|
Facility
|
OP
|
$975.00
|
|
| Hospital Charge Code |
64905784
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$536.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$487.50
|
| Rate for Payer: Aetna Government |
$487.50
|
| Rate for Payer: Brighton Health Commercial |
$731.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$780.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$663.00
|
| Rate for Payer: Group Health Inc Commercial |
$487.50
|
| Rate for Payer: Group Health Inc Medicare |
$341.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$487.50
|
|
|
PTA 4X10
|
Facility
|
OP
|
$787.50
|
|
| Hospital Charge Code |
64905786
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$275.62 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$433.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$393.75
|
| Rate for Payer: Aetna Government |
$393.75
|
| Rate for Payer: Brighton Health Commercial |
$590.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$630.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$535.50
|
| Rate for Payer: Group Health Inc Commercial |
$393.75
|
| Rate for Payer: Group Health Inc Medicare |
$275.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$393.75
|
|
|
PTA 4X10
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
64905782
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.50
|
| Rate for Payer: Aetna Government |
$212.50
|
| Rate for Payer: Brighton Health Commercial |
$318.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$340.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$289.00
|
| Rate for Payer: Group Health Inc Commercial |
$212.50
|
| Rate for Payer: Group Health Inc Medicare |
$148.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.50
|
|
|
PT ADL TRAINING 15 MTS
|
Facility
|
OP
|
$99.85
|
|
|
Service Code
|
HCPCS 97535 GP
|
| Hospital Charge Code |
41701130
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PT AIRCAST W/FITTING
|
Facility
|
OP
|
$158.76
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
41709452
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$166.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.82
|
| Rate for Payer: Aetna Government |
$43.82
|
| Rate for Payer: Brighton Health Commercial |
$95.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.29
|
| Rate for Payer: EmblemHealth Commercial |
$79.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.70
|
| Rate for Payer: Group Health Inc Commercial |
$79.38
|
| Rate for Payer: Group Health Inc Medicare |
$55.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.19
|
|
|
PT APPLICATION LONG LEG SPLINT
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
41709445
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$182.22
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT APPLICATION LONG LEG SPLINT
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
41709445
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
PT APPLICATION SHORT LEG CAST
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
41709448
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.40
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| 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 |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$310.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$310.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$310.57
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.98
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: Humana Medicare |
$316.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT APPLICATION SHORT LEG CAST
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
41709448
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$310.57
|
|
|
PT APPLICATION SHORT LEG SPLINT
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
41709446
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
PT APPLICATION SHORT LEG SPLINT
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
41709446
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$182.22
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT APPLICATION UNNA BOOT
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
41709433
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$182.22
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT APPLICATION UNNA BOOT
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
41709433
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
PT BIOFEEDBACK TRAIN. BY ANY MODA
|
Facility
|
OP
|
$57.33
|
|
|
Service Code
|
HCPCS 90901 GP
|
| Hospital Charge Code |
41701145
|
|
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
|
|
|
PT BURN DRESS/DEBRIDE LARGE AREA
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
41709414
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
PT BURN DRESS/DEBRIDE LARGE AREA
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
41709414
|
|
Hospital Revenue Code
|
519
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
PT BURN DRESS/DEBRIDE MED. AREA
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
41709413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
PT BURN DRESS/DEBRIDE MED. AREA
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
41709413
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
PT BURN DRESS/DEBRIDE SMALL AREA
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
41709412
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
PT BURN DRESS/DEBRIDE SMALL AREA
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
41709412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
PT CANES (FIXED)
|
Facility
|
OP
|
$52.09
|
|
|
Service Code
|
HCPCS E0100
|
| Hospital Charge Code |
41709402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.34
|
| Rate for Payer: Aetna Government |
$17.34
|
| Rate for Payer: Brighton Health Commercial |
$39.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.42
|
| Rate for Payer: Group Health Inc Commercial |
$26.04
|
| Rate for Payer: Group Health Inc Medicare |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.04
|
|
|
PT/CAREGIRVER TRAIN HOME INR
|
Facility
|
OP
|
$358.69
|
|
|
Service Code
|
HCPCS 93792
|
| Hospital Charge Code |
30307815
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.63
|
| Rate for Payer: Aetna Government |
$49.63
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.34
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
PT CAST SUPPLIES FOR UNNA BOOT
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
HCPCS Q4050
|
| Hospital Charge Code |
41709434
|
|
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 |
$7.09
|
| Rate for Payer: Aetna Government |
$7.09
|
| 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
|
|
|
PT CERVICAL COLLAR FOAM
|
Facility
|
OP
|
$70.88
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
41709430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Brighton Health Commercial |
$42.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.76
|
| Rate for Payer: EmblemHealth Commercial |
$35.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.42
|
| Rate for Payer: Group Health Inc Commercial |
$35.44
|
| Rate for Payer: Group Health Inc Medicare |
$24.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.07
|
|
|
PT CERVICAL COLLAR,SEMI-RIGID 2PC
|
Facility
|
OP
|
$31.05
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
41709431
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$32.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Brighton Health Commercial |
$18.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.85
|
| Rate for Payer: EmblemHealth Commercial |
$15.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.60
|
| Rate for Payer: Group Health Inc Commercial |
$15.52
|
| Rate for Payer: Group Health Inc Medicare |
$10.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.18
|
|
