|
HC APPLY FOREARM SPLINT,DYNAMIC
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
5102912601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
5102912501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
5102912501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| 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 |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC APPLY HAND / WRIST CAST
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
5102908501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC APPLY HAND / WRIST CAST
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
5102908501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| 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 |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.37 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
5102906501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
5102910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
5102910501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.71 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| 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 |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC APPLY LONG LEG CAST
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
5102934501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC APPLY LONG LEG CAST
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
5102934501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.00
|
|
|
HC APPLY LONG LEG CAST BRACE
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
5102935801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC APPLY LONG LEG CAST BRACE
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
5102935801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.00
|
|
|
HC APPLY LONG LEG CAST,CYLINDER
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
5102936501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
|
|
HC APPLY LONG LEG CAST,CYLINDER
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
5102936501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC APPLY LONG LEG CAST,WALKER
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
5102935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC APPLY LONG LEG CAST,WALKER
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
5102935501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$359.50 |
| Max. Negotiated Rate |
$359.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.50
|
|
|
HC APPLY LONG LEG SPLINT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
5102950501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC APPLY LONG LEG SPLINT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
5102950501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.47 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| 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 |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
5102951501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| 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 |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
5102951501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC APPLY OF HIP CAST,ONE LEG
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
5102930501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$142.53 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC APPLY OF HIP CAST,ONE LEG
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
5102930501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.00
|
|
|
HC APPLY OF HIP CASTS,TWO LEGS
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
5102932501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$359.50 |
| Max. Negotiated Rate |
$359.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.50
|
|
|
HC APPLY OF HIP CASTS,TWO LEGS
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
5102932501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$142.53 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
