|
PTCH HERNIA COMP KUGEL SM CIR W/E
|
Facility
|
OP
|
$2,014.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40201109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$2,114.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,107.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Brighton Health Commercial |
$1,208.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,007.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,158.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,007.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,114.70
|
| Rate for Payer: Group Health Inc Commercial |
$1,007.00
|
| Rate for Payer: Group Health Inc Medicare |
$704.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,007.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,007.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,309.10
|
|
|
PTCH HERNIA COMP KUGEL SM CIR W/E
|
Facility
|
IP
|
$2,014.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40201109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.00 |
| Max. Negotiated Rate |
$1,007.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,007.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,007.00
|
|
|
PT COMORB DX 12M OF EPI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2175
|
| Hospital Charge Code |
30300303
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
PT - CONTRAST BATH 15 MTS
|
Facility
|
OP
|
$44.20
|
|
|
Service Code
|
HCPCS 97034 GP
|
| Hospital Charge Code |
41701115
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PT CRUTCHES (PAIR)
|
Facility
|
OP
|
$70.86
|
|
|
Service Code
|
HCPCS E0114
|
| Hospital Charge Code |
41709401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$56.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.17
|
| Rate for Payer: Aetna Government |
$36.17
|
| Rate for Payer: Brighton Health Commercial |
$53.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.18
|
| Rate for Payer: Group Health Inc Commercial |
$35.43
|
| Rate for Payer: Group Health Inc Medicare |
$24.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.43
|
|
|
PT DIATHERMY
|
Facility
|
OP
|
$21.33
|
|
|
Service Code
|
HCPCS 97024 GP
|
| Hospital Charge Code |
41701110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.97
|
| Rate for Payer: Aetna Government |
$3.97
|
| 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 |
$10.66
|
| 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 |
$10.66
|
| 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
|
|
|
PT DISPOSABLE ELECTRODES
|
Facility
|
OP
|
$39.66
|
|
|
Service Code
|
HCPCS A4556
|
| Hospital Charge Code |
41709460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.39
|
| Rate for Payer: Aetna Government |
$7.39
|
| Rate for Payer: Brighton Health Commercial |
$29.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.97
|
| Rate for Payer: Group Health Inc Commercial |
$19.83
|
| Rate for Payer: Group Health Inc Medicare |
$13.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.83
|
|
|
PT E-STIM (MANUAL-ATTENDED) 15 MT
|
Facility
|
OP
|
$42.63
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
41701113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| 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 |
$21.32
|
| 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 |
$21.32
|
| 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
|
|
|
PT E-STIM(UNATTENDED)
|
Facility
|
OP
|
$32.60
|
|
|
Service Code
|
HCPCS 97014 GP
|
| Hospital Charge Code |
41701105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.69
|
| Rate for Payer: Aetna Government |
$9.69
|
| 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 |
$16.30
|
| 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 |
$16.30
|
| 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
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
OP
|
$249.25
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
41709553
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$19,030.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.11
|
| Rate for Payer: Aetna Government |
$49.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$428.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$428.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.30
|
| Rate for Payer: Amida Care Medicaid |
$190.30
|
| 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: Fidelis CHP/HARP/Medicaid |
$19,030.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$190.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.82
|
| Rate for Payer: Group Health Inc Commercial |
$124.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.30
|
| Rate for Payer: Healthfirst Essential Plan |
$428.18
|
| Rate for Payer: Healthfirst QHP |
$190.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.30
|
| Rate for Payer: SOMOS Essential |
$428.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$428.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$209.33
|
| Rate for Payer: United Healthcare Medicaid |
$190.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$190.30
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
OP
|
$249.25
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
41709551
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$11,418.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.11
|
| Rate for Payer: Aetna Government |
$49.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$256.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$256.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$114.18
|
| Rate for Payer: Amida Care Medicaid |
$114.18
|
| 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 |
$11,418.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.89
|
| Rate for Payer: Group Health Inc Commercial |
$124.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.18
|
| Rate for Payer: Healthfirst Essential Plan |
$256.90
|
| Rate for Payer: Healthfirst QHP |
$114.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.18
|
| Rate for Payer: SOMOS Essential |
$256.90
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$256.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$125.60
|
| Rate for Payer: United Healthcare Medicaid |
$114.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$114.18
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
OP
|
$249.25
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
41709552
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$15,224.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.11
|
| Rate for Payer: Aetna Government |
$49.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$342.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$342.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$152.24
|
| Rate for Payer: Amida Care Medicaid |
$152.24
|
| 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 |
$15,224.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.85
|
| Rate for Payer: Group Health Inc Commercial |
$124.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.24
|
| Rate for Payer: Healthfirst Essential Plan |
$342.54
|
| Rate for Payer: Healthfirst QHP |
$152.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.24
|
| Rate for Payer: SOMOS Essential |
$342.54
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$342.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$167.46
|
| Rate for Payer: United Healthcare Medicaid |
$152.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$152.24
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT EZ BOOT
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS L4398
|
| Hospital Charge Code |
41709455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.54 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.54
|
| Rate for Payer: Aetna Government |
$39.54
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$75.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.25
|
| Rate for Payer: EmblemHealth Commercial |
$75.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.50
|
| Rate for Payer: Group Health Inc Commercial |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.50
|
|
|
PT - FUCTIONAL PERFORMANCE 15 MTS
|
Facility
|
OP
|
$116.13
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
41701129
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.87
|
| Rate for Payer: Aetna Government |
$20.87
|
| 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 |
$58.06
|
| 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 |
$58.06
|
| 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
|
|
|
PT GAIT TRAINING 15 MTS
|
Facility
|
OP
|
$88.03
|
|
|
Service Code
|
HCPCS 97116 GP
|
| Hospital Charge Code |
41701122
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.96
|
| Rate for Payer: Aetna Government |
$16.96
|
| 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 |
$44.02
|
| 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 |
$44.02
|
| 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
|
|
|
PT HAND HELPER
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
HCPCS A9300
|
| Hospital Charge Code |
41709428
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.85
|
| Rate for Payer: Aetna Government |
$7.85
|
| Rate for Payer: Brighton Health Commercial |
$13.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.53
|
| Rate for Payer: Group Health Inc Commercial |
$9.22
|
| Rate for Payer: Group Health Inc Medicare |
$6.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.22
|
|
|
PT HOT/COLD PACKS
|
Facility
|
OP
|
$36.86
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
41701103
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.75
|
| Rate for Payer: Aetna Government |
$3.75
|
| 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 |
$18.43
|
| 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 |
$18.43
|
| 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
|
|
|
PTHRP (PTH-RELATED PEPTIDE)
|
Facility
|
IP
|
$35.30
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
40609052
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.12
|
|
|
PTHRP (PTH-RELATED PEPTIDE)
|
Facility
|
OP
|
$35.30
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
40609052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.88
|
| Rate for Payer: Brighton Health Commercial |
$26.48
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.12
|
| Rate for Payer: EmblemHealth Commercial |
$14.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.57
|
| Rate for Payer: Group Health Inc Commercial |
$14.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.12
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$17.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.30
|
| Rate for Payer: Wellcare Medicare |
$12.71
|
|
|
PT HUBBARD TANK 15 MTS
|
Facility
|
OP
|
$104.63
|
|
|
Service Code
|
HCPCS 97036 GP
|
| Hospital Charge Code |
41701117
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.11
|
| Rate for Payer: Aetna Government |
$20.11
|
| 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 |
$52.32
|
| 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 |
$52.32
|
| 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
|
|
|
PT IONTOPHORESIS 15 MTS
|
Facility
|
OP
|
$60.78
|
|
|
Service Code
|
HCPCS 97033 GP
|
| Hospital Charge Code |
41701114
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.94
|
| Rate for Payer: Aetna Government |
$15.94
|
| 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 |
$30.39
|
| 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 |
$30.39
|
| 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
|
|
|
PT KINESTHETIC TAPING KIT W/O REM
|
Facility
|
OP
|
$36.86
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
41709429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$29.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$27.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.06
|
| Rate for Payer: Group Health Inc Commercial |
$18.43
|
| Rate for Payer: Group Health Inc Medicare |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.43
|
|
|
PT LEG EXTENSIONS FOR WALKER
|
Facility
|
OP
|
$53.87
|
|
|
Service Code
|
HCPCS E0158
|
| Hospital Charge Code |
41709423
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$43.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.37
|
| Rate for Payer: Aetna Government |
$16.37
|
| Rate for Payer: Brighton Health Commercial |
$40.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.63
|
| Rate for Payer: Group Health Inc Commercial |
$26.94
|
| Rate for Payer: Group Health Inc Medicare |
$18.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.94
|
|
|
PT LSO BRACE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS L0462
|
| Hospital Charge Code |
41702195
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$638.98
|
| Rate for Payer: Aetna Government |
$638.98
|
| Rate for Payer: Brighton Health Commercial |
$450.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$375.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$431.25
|
| Rate for Payer: EmblemHealth Commercial |
$375.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$787.50
|
| Rate for Payer: Group Health Inc Commercial |
$375.00
|
| Rate for Payer: Group Health Inc Medicare |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$487.50
|
|
|
PTM ADL TRAINING 15 MTS
|
Facility
|
OP
|
$99.85
|
|
|
Service Code
|
HCPCS 97535 GP
|
| Hospital Charge Code |
41702130
|
|
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
|
|
