|
EVAL-PRESCRIPT VOICE PROSTHETI (W/ KX)
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN,KX
|
| Hospital Charge Code |
4670265
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$460.46 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$263.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$211.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: CDPHP Commercial |
$460.46
|
| Rate for Payer: CDPHP Medicare |
$211.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$457.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$457.60
|
| Rate for Payer: EmblemHealth Medicaid |
$457.60
|
| Rate for Payer: EmblemHealth Medicare |
$194.48
|
| Rate for Payer: EmblemHealth Select Care |
$411.84
|
| Rate for Payer: Fidelis Medicare |
$217.99
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$211.64
|
| Rate for Payer: Humana Medicare |
$211.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.12
|
| 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 |
$222.22
|
| 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 |
$211.64
|
| Rate for Payer: WellCare Medicare |
$314.60
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (W/ KX)
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 92597 GN,KX
|
| Hospital Charge Code |
4670265
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$371.80 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Galaxy Health Commercial |
$371.80
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN
|
| Hospital Charge Code |
4670022
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN
|
| Hospital Charge Code |
4670022
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$148.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Commercial |
$322.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$320.00
|
| Rate for Payer: EmblemHealth Medicaid |
$320.00
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$152.44
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$148.00
|
| Rate for Payer: Humana Medicare |
$148.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| 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 |
$155.40
|
| 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 |
$148.00
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59
|
| Hospital Charge Code |
4670286
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$148.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Commercial |
$322.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$320.00
|
| Rate for Payer: EmblemHealth Medicaid |
$320.00
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$152.44
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$148.00
|
| Rate for Payer: Humana Medicare |
$148.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| 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 |
$155.40
|
| 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 |
$148.00
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59
|
| Hospital Charge Code |
4670286
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59 W KX)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59,KX
|
| Hospital Charge Code |
4670302
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$148.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Commercial |
$322.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$320.00
|
| Rate for Payer: EmblemHealth Medicaid |
$320.00
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$152.44
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$148.00
|
| Rate for Payer: Humana Medicare |
$148.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| 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 |
$155.40
|
| 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 |
$148.00
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59 W KX)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59,KX
|
| Hospital Charge Code |
4670302
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (W/ KX)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,KX
|
| Hospital Charge Code |
4670264
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$148.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Commercial |
$322.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$320.00
|
| Rate for Payer: EmblemHealth Medicaid |
$320.00
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$152.44
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$148.00
|
| Rate for Payer: Humana Medicare |
$148.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| 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 |
$155.40
|
| 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 |
$148.00
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (W/ KX)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,KX
|
| Hospital Charge Code |
4670264
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN
|
| Hospital Charge Code |
4670083
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN
|
| Hospital Charge Code |
4670083
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$651.24 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$372.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$299.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: CDPHP Commercial |
$651.24
|
| Rate for Payer: CDPHP Medicare |
$299.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$647.20
|
| Rate for Payer: EmblemHealth Medicaid |
$647.20
|
| Rate for Payer: EmblemHealth Medicare |
$275.06
|
| Rate for Payer: EmblemHealth Select Care |
$582.48
|
| Rate for Payer: Fidelis Medicare |
$308.31
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$299.33
|
| Rate for Payer: Humana Medicare |
$299.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$372.14
|
| 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 |
$314.30
|
| 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 |
$299.33
|
| Rate for Payer: WellCare Medicare |
$444.95
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (MOD 59)
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59
|
| Hospital Charge Code |
4670291
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (MOD 59)
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59
|
| Hospital Charge Code |
4670291
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$651.24 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$372.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$299.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: CDPHP Commercial |
$651.24
|
| Rate for Payer: CDPHP Medicare |
$299.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$647.20
|
| Rate for Payer: EmblemHealth Medicaid |
$647.20
|
| Rate for Payer: EmblemHealth Medicare |
$275.06
|
| Rate for Payer: EmblemHealth Select Care |
$582.48
|
| Rate for Payer: Fidelis Medicare |
$308.31
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$299.33
|
| Rate for Payer: Humana Medicare |
$299.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$372.14
|
| 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 |
$314.30
|
| 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 |
$299.33
|
| Rate for Payer: WellCare Medicare |
$444.95
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (MOD 59 W KX)
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59,KX
|
| Hospital Charge Code |
4670307
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (MOD 59 W KX)
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59,KX
|
| Hospital Charge Code |
4670307
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$651.24 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$372.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$299.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: CDPHP Commercial |
$651.24
|
| Rate for Payer: CDPHP Medicare |
$299.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$647.20
|
| Rate for Payer: EmblemHealth Medicaid |
$647.20
|
| Rate for Payer: EmblemHealth Medicare |
$275.06
|
| Rate for Payer: EmblemHealth Select Care |
$582.48
|
| Rate for Payer: Fidelis Medicare |
$308.31
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$299.33
|
| Rate for Payer: Humana Medicare |
$299.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$372.14
|
| 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 |
$314.30
|
| 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 |
$299.33
|
| Rate for Payer: WellCare Medicare |
$444.95
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (W/ KX)
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,KX
|
| Hospital Charge Code |
4670269
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$651.24 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$372.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$606.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$299.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: CDPHP Commercial |
$651.24
|
| Rate for Payer: CDPHP Medicare |
$299.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$647.20
|
| Rate for Payer: EmblemHealth Medicaid |
$647.20
|
| Rate for Payer: EmblemHealth Medicare |
$275.06
|
| Rate for Payer: EmblemHealth Select Care |
$582.48
|
| Rate for Payer: Fidelis Medicare |
$308.31
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$299.33
|
| Rate for Payer: Humana Medicare |
$299.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$372.14
|
| 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 |
$314.30
|
| 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 |
$299.33
|
| Rate for Payer: WellCare Medicare |
$444.95
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (W/ KX)
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,KX
|
| Hospital Charge Code |
4670269
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN
|
| Hospital Charge Code |
4670018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$272.09 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Commercial |
$272.09
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$128.81
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.06
|
| Rate for Payer: Humana Medicare |
$125.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| 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 |
$131.31
|
| 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 |
$125.06
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN
|
| Hospital Charge Code |
4670018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59)
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59
|
| Hospital Charge Code |
4670284
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59)
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59
|
| Hospital Charge Code |
4670284
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$272.09 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Commercial |
$272.09
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$128.81
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.06
|
| Rate for Payer: Humana Medicare |
$125.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| 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 |
$131.31
|
| 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 |
$125.06
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59 W KX)
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59,KX
|
| Hospital Charge Code |
4670300
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$272.09 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Commercial |
$272.09
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$128.81
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.06
|
| Rate for Payer: Humana Medicare |
$125.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| 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 |
$131.31
|
| 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 |
$125.06
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59 W KX)
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59,KX
|
| Hospital Charge Code |
4670300
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (W/ KX)
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,KX
|
| Hospital Charge Code |
4670262
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$272.09 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$253.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Commercial |
$272.09
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$128.81
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.06
|
| Rate for Payer: Humana Medicare |
$125.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| 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 |
$131.31
|
| 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 |
$125.06
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
