|
ELECTRICAL STIMULATION EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59
|
| Hospital Charge Code |
4650395
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
ELECTRICAL STIMULATION EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59
|
| Hospital Charge Code |
4650395
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
ELECTRICAL STIMULATION EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59,KX
|
| Hospital Charge Code |
4650447
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
ELECTRICAL STIMULATION EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59,KX
|
| Hospital Charge Code |
4650447
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
ELECTRICAL STIMULATION EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,KX
|
| Hospital Charge Code |
4650343
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
ELECTRICAL STIMULATION EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,KX
|
| Hospital Charge Code |
4650343
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP
|
| Hospital Charge Code |
4650077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP
|
| Hospital Charge Code |
4650077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP,59
|
| Hospital Charge Code |
4650392
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP,59
|
| Hospital Charge Code |
4650392
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP,59,KX
|
| Hospital Charge Code |
4650444
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP,59,KX
|
| Hospital Charge Code |
4650444
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP,KX
|
| Hospital Charge Code |
4650340
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GP,KX
|
| Hospital Charge Code |
4650340
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
ELECTROLYTE PANEL
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
4300294
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$20.15
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$18.60
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$23.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Commercial |
$23.25
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
ELECTROLYTE PANEL
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
4300294
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
ELECTROLYTES (URINE)
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
4300846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
ELECTROLYTES (URINE)
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
4300846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna of NY Commercial |
$20.15
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.50
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Commercial |
$24.96
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$18.60
|
| Rate for Payer: Fidelis Medicare |
$11.81
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.47
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$23.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.10
|
| Rate for Payer: United Healthcare Commercial |
$23.25
|
| Rate for Payer: United Healthcare Medicare |
$11.47
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITH REPROGRAMMING
|
Facility
|
OP
|
$2,521.93
|
|
|
Service Code
|
CPT 62368
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$284.59 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$636.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$284.59
|
| Rate for Payer: United Healthcare Commercial |
$1,775.00
|
|
|
ELIM PYLORIC/COLONIC
|
Facility
|
OP
|
$387.00
|
|
| Hospital Charge Code |
4471005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.58 |
| Max. Negotiated Rate |
$311.54 |
| Rate for Payer: Aetna of NY Commercial |
$270.90
|
| Rate for Payer: Aetna of NY Medicare |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$290.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$290.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$143.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$193.50
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: CDPHP Commercial |
$311.54
|
| Rate for Payer: CDPHP Medicare |
$143.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$309.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$309.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$309.60
|
| Rate for Payer: EmblemHealth Medicaid |
$309.60
|
| Rate for Payer: EmblemHealth Medicare |
$131.58
|
| Rate for Payer: EmblemHealth Select Care |
$278.64
|
| Rate for Payer: Fidelis Medicare |
$147.49
|
| Rate for Payer: Galaxy Health Commercial |
$251.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$143.19
|
| Rate for Payer: Humana Medicare |
$143.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$270.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$178.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$290.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$217.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$150.35
|
| Rate for Payer: United Healthcare Medicare |
$143.19
|
| Rate for Payer: WellCare Medicare |
$212.85
|
|
|
ELIM PYLORIC/COLONIC
|
Facility
|
IP
|
$387.00
|
|
| Hospital Charge Code |
4471005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$251.55 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Galaxy Health Commercial |
$251.55
|
|
|
ELIQUIS 2.5 MG TABLET
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
4409209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Aetna of NY Commercial |
$15.50
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Commercial |
$17.83
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$15.95
|
| Rate for Payer: Fidelis Medicare |
$8.44
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.20
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.61
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
ELIQUIS 2.5 MG TABLET
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
4409209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
ELIQUIS TAB 5 MG
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
4409202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Aetna of NY Commercial |
$15.50
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Commercial |
$17.83
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$15.95
|
| Rate for Payer: Fidelis Medicare |
$8.44
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.20
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.61
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
ELIQUIS TAB 5 MG
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
4409202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
