|
PT WALKER ADJ. FOLDING
|
Facility
|
OP
|
$203.76
|
|
|
Service Code
|
HCPCS E0135
|
| Hospital Charge Code |
41709404
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$163.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$112.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.47
|
| Rate for Payer: Aetna Government |
$45.47
|
| Rate for Payer: Brighton Health Commercial |
$152.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$163.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.56
|
| Rate for Payer: Group Health Inc Commercial |
$101.88
|
| Rate for Payer: Group Health Inc Medicare |
$71.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.88
|
|
|
PT WALKER - HEAVY DUTY
|
Facility
|
OP
|
$467.78
|
|
|
Service Code
|
HCPCS E0148
|
| Hospital Charge Code |
41709420
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$374.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$257.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.49
|
| Rate for Payer: Aetna Government |
$73.49
|
| Rate for Payer: Brighton Health Commercial |
$350.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$374.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$318.09
|
| Rate for Payer: Group Health Inc Commercial |
$233.89
|
| Rate for Payer: Group Health Inc Medicare |
$163.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.89
|
|
|
PT WALKER W/WHEELS - FOLDING
|
Facility
|
OP
|
$288.97
|
|
|
Service Code
|
HCPCS E0143
|
| Hospital Charge Code |
41709419
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$231.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.52
|
| Rate for Payer: Aetna Government |
$62.52
|
| Rate for Payer: Brighton Health Commercial |
$216.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$231.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$196.50
|
| Rate for Payer: Group Health Inc Commercial |
$144.48
|
| Rate for Payer: Group Health Inc Medicare |
$101.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.48
|
|
|
PT WHEEL CHAIR TRAINING 15 MTS
|
Facility
|
OP
|
$96.25
|
|
|
Service Code
|
HCPCS 97542 GP
|
| Hospital Charge Code |
41701132
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$5,477.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.52
|
| Rate for Payer: Aetna Government |
$18.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$123.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$123.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$54.77
|
| Rate for Payer: Amida Care Medicaid |
$54.77
|
| 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 |
$5,477.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.51
|
| Rate for Payer: Group Health Inc Commercial |
$48.12
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.77
|
| Rate for Payer: Healthfirst Essential Plan |
$123.23
|
| Rate for Payer: Healthfirst QHP |
$54.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.77
|
| Rate for Payer: SOMOS Essential |
$123.23
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$123.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$60.25
|
| Rate for Payer: United Healthcare Medicaid |
$54.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$54.77
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT WHIRLPOOL
|
Facility
|
OP
|
$53.30
|
|
|
Service Code
|
HCPCS 97022 GP
|
| Hospital Charge Code |
41701109
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.37
|
| Rate for Payer: Aetna Government |
$14.37
|
| 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 |
$26.65
|
| 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 |
$26.65
|
| 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 WOUNDCARE-NON SELEC. DEBRIDMNT
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
41709411
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
PT WOUNDCARE-NON SELEC. DEBRIDMNT
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
41709411
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| 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 |
$182.00
|
| Rate for Payer: Cash Price |
$231.52
|
| 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 |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$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 |
$120.00
|
| 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 |
$222.00
|
| 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 |
$55.00
|
|
|
PT WOUNDCARE SELECTIVE < 20CM
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
41709520
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| 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 |
$182.00
|
| Rate for Payer: Cash Price |
$231.52
|
| 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 |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$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 |
$120.00
|
| 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 |
$222.00
|
| 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 |
$55.00
|
|
|
PT WOUNDCARE SELECTIVE < 20CM
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
41709520
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
PT WOUNDCARE SELECTIVE > 20 CM
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
41709521
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.26
|
| Rate for Payer: Aetna Government |
$9.26
|
| 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 |
$264.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.62
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PT WOUND CARE-SELECTIVE DEBRDMENT
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
41709518
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| 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 |
$182.00
|
| Rate for Payer: Cash Price |
$231.52
|
| 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 |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$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 |
$120.00
|
| 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 |
$222.00
|
| 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 |
$55.00
|
|
|
PT WOUND CARE-SELECTIVE DEBRDMENT
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
41709518
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
PTX STENT
|
Facility
|
IP
|
$4,487.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
64903548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.75 |
| Max. Negotiated Rate |
$2,243.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,243.75
|
|
|
PTX STENT
|
Facility
|
OP
|
$4,487.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
64903548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$4,711.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,468.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Brighton Health Commercial |
$2,692.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,243.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,580.31
|
| Rate for Payer: EmblemHealth Commercial |
$2,243.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,711.88
|
| Rate for Payer: Group Health Inc Commercial |
$2,243.75
|
| Rate for Payer: Group Health Inc Medicare |
$1,570.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,243.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,916.88
|
|
|
PUDENAL NERVE
|
Facility
|
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64630
|
| Hospital Charge Code |
30305727
|
|
Hospital Revenue Code
|
510
|
| 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 |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$737.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$737.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$737.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Humana Medicare |
$1,075.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
PUDENAL NERVE
|
Facility
|
IP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64630
|
| Hospital Charge Code |
30305727
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,054.06
|
|
|
PUDENDAL NERVE
|
Facility
|
IP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64430
|
| Hospital Charge Code |
30305032
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,054.06
|
|
|
PUDENDAL NERVE
|
Facility
|
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64430
|
| Hospital Charge Code |
30305032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$737.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$737.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$737.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Humana Medicare |
$1,075.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
PUDENZ VALVE
|
Facility
|
OP
|
$303.70
|
|
| Hospital Charge Code |
40000310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$242.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$167.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$151.85
|
| Rate for Payer: Aetna Government |
$151.85
|
| Rate for Payer: Brighton Health Commercial |
$227.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$242.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$206.52
|
| Rate for Payer: Group Health Inc Commercial |
$151.85
|
| Rate for Payer: Group Health Inc Medicare |
$106.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.85
|
|
|
PULM FUNCTION TEST BY GAS
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 94727 TC
|
| Hospital Charge Code |
30305587
|
|
Hospital Revenue Code
|
460
|
| 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: 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 |
$209.52
|
| 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
|
|
|
PULM FUNCTION TEST BY GAS
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 94727 TC
|
| Hospital Charge Code |
30305587
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
PULM FUNCT TST PLETHYSMOOGRAPHY
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94726 TC
|
| Hospital Charge Code |
30305586
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$383.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
PULM FUNCT TST PLETHYSMOOGRAPHY
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 94726 TC
|
| Hospital Charge Code |
30305586
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$33,567.15
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$10,564.40 |
| Max. Negotiated Rate |
$33,567.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,165.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,412.47
|
| Rate for Payer: Aetna Government |
$24,412.47
|
| Rate for Payer: Brighton Health Commercial |
$17,864.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,900.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,275.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,557.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,191.85
|
| Rate for Payer: EmblemHealth Commercial |
$10,564.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,412.47
|
| Rate for Payer: Group Health Inc Commercial |
$24,412.47
|
| Rate for Payer: Group Health Inc Medicare |
$24,412.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,412.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,351.80
|
| Rate for Payer: Humana Medicare |
$33,567.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,412.47
|
| Rate for Payer: United Healthcare Commercial |
$24,500.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,412.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,412.47
|
| Rate for Payer: Wellcare Medicare |
$23,191.85
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$36,827.70
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$12,030.70 |
| Max. Negotiated Rate |
$36,827.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,687.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,783.78
|
| Rate for Payer: Aetna Government |
$26,783.78
|
| Rate for Payer: Brighton Health Commercial |
$20,343.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,319.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,228.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,994.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,444.59
|
| Rate for Payer: EmblemHealth Commercial |
$12,030.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,783.78
|
| Rate for Payer: Group Health Inc Commercial |
$26,783.78
|
| Rate for Payer: Group Health Inc Medicare |
$26,783.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,783.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,454.46
|
| Rate for Payer: Humana Medicare |
$36,827.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,783.78
|
| Rate for Payer: United Healthcare Commercial |
$27,901.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,783.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,783.78
|
| Rate for Payer: Wellcare Medicare |
$25,444.59
|
|
