|
PT STRAPPING SHOULDER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
41709441
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
PT STRAPPING TOES
|
Facility
|
OP
|
$170.35
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
41709435
|
|
Hospital Revenue Code
|
420
|
| 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 |
$85.18
|
| 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
|
|
|
PT STRAPPING TOES
|
Facility
|
IP
|
$170.35
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
41709435
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
PTT- AIR & BONE
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 92553
|
| Hospital Charge Code |
42004501
|
|
Hospital Revenue Code
|
471
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
PTT- AIR & BONE
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 92553
|
| Hospital Charge Code |
42004501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
PTT-AIR ONLY
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 92552
|
| Hospital Charge Code |
42004500
|
|
Hospital Revenue Code
|
471
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
PTT-AIR ONLY
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 92552
|
| Hospital Charge Code |
42004500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
PT TAPE WATERPROOF
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
41709461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
|
|
PT THERAPUTTY
|
Facility
|
OP
|
$15.59
|
|
|
Service Code
|
HCPCS A9300
|
| Hospital Charge Code |
41709427
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.85
|
| Rate for Payer: Aetna Government |
$7.85
|
| Rate for Payer: Brighton Health Commercial |
$11.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.60
|
| Rate for Payer: Group Health Inc Commercial |
$7.80
|
| Rate for Payer: Group Health Inc Medicare |
$5.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.80
|
|
|
PT THERATUBING
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
HCPCS A9300
|
| Hospital Charge Code |
41709426
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.85
|
| Rate for Payer: Aetna Government |
$7.85
|
| Rate for Payer: Brighton Health Commercial |
$9.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
PT THERP.PROCE 0NE/MORE AREA 15MT
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
HCPCS 97110 GP
|
| Hospital Charge Code |
41701119
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.41
|
| Rate for Payer: Aetna Government |
$19.41
|
| 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 |
$44.55
|
| 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 |
$44.55
|
| 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 THERP.PROCE. GROUP(2 OR MORE)
|
Facility
|
OP
|
$52.88
|
|
|
Service Code
|
HCPCS 97150 GP
|
| Hospital Charge Code |
41701126
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.34
|
| Rate for Payer: Aetna Government |
$10.34
|
| 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 |
$26.44
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PTT LA
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
40629226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.14
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
PTT LA
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
40629226
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$6.47
|
|
|
PT TLSO BRACE
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS L0631
|
| Hospital Charge Code |
41702196
|
|
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 |
$525.36
|
| Rate for Payer: Aetna Government |
$525.36
|
| 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
|
|
|
PT TOBACCO SCRN RCVD TLK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 4004F
|
| Hospital Charge Code |
30307860
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| 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
|
|
|
PT TRACTION,MANUAL
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
HCPCS 97012 GP
|
| Hospital Charge Code |
41701104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.54
|
| Rate for Payer: Aetna Government |
$9.54
|
| 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 |
$21.85
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.85
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT ULISTED MODALITY
|
Facility
|
OP
|
$36.86
|
|
|
Service Code
|
HCPCS 97039 GP
|
| Hospital Charge Code |
41701118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.02
|
| Rate for Payer: Aetna Government |
$11.02
|
| 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
|
|
|
PT ULTRASOUND 15 MTS
|
Facility
|
OP
|
$42.05
|
|
|
Service Code
|
HCPCS 97035 GP
|
| Hospital Charge Code |
41701116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.63
|
| Rate for Payer: Aetna Government |
$7.63
|
| 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 |
$21.02
|
| 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 |
$21.02
|
| 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 UNLISTED PT PROCEDURE
|
Facility
|
OP
|
$70.88
|
|
|
Service Code
|
HCPCS 97799 GP
|
| Hospital Charge Code |
41701138
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.44
|
| Rate for Payer: Aetna Government |
$35.44
|
| 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 |
$35.44
|
| 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 |
$35.44
|
| 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 UNLISTED THERP.PROCEDURE 15MTS
|
Facility
|
OP
|
$31.19
|
|
|
Service Code
|
HCPCS 97139 GP
|
| Hospital Charge Code |
41701124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.91
|
| Rate for Payer: Aetna Government |
$14.91
|
| 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 |
$15.60
|
| 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 |
$15.60
|
| 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 UNNA BOOT/MULTILAYER COMPRESSI
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
41702197
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
PT UNNA BOOT/MULTILAYER COMPRESSI
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
41702197
|
|
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 VASOPNEUMATIC DEVICE
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 97016 GP
|
| Hospital Charge Code |
41701106
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.69
|
| Rate for Payer: Aetna Government |
$11.69
|
| 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 |
$17.99
|
| 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 |
$17.99
|
| 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 VOCATIONAL REHAB 15 MTS
|
Facility
|
OP
|
$95.18
|
|
|
Service Code
|
HCPCS 97537 GP
|
| Hospital Charge Code |
41701131
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$5,078.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.08
|
| Rate for Payer: Aetna Government |
$18.08
|
| 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 |
$47.59
|
| 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 |
$47.59
|
| 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
|
|
