|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (W/ KX)
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,KX
|
| Hospital Charge Code |
4670262
|
|
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 PT USE OF INHALER IPPB
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
4530011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$491.05 |
| Rate for Payer: Aetna of NY Commercial |
$427.00
|
| Rate for Payer: Aetna of NY Medicare |
$280.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$457.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$225.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$305.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: CDPHP Commercial |
$491.05
|
| Rate for Payer: CDPHP Medicare |
$225.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$488.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$488.00
|
| Rate for Payer: EmblemHealth Medicaid |
$488.00
|
| Rate for Payer: EmblemHealth Medicare |
$207.40
|
| Rate for Payer: EmblemHealth Select Care |
$439.20
|
| Rate for Payer: Fidelis Medicare |
$232.47
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$225.70
|
| Rate for Payer: Humana Medicare |
$225.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$427.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$280.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$457.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$343.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$236.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.03
|
| Rate for Payer: United Healthcare Medicare |
$225.70
|
| Rate for Payer: WellCare Medicare |
$335.50
|
|
|
EVALUATE PT USE OF INHALER IPPB
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
4530011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$396.50 |
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Galaxy Health Commercial |
$396.50
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN
|
| Hospital Charge Code |
4670257
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN
|
| Hospital Charge Code |
4670257
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$321.84
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| 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 |
$173.66
|
| 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 |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59)
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN,59
|
| Hospital Charge Code |
4670295
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$321.84
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| 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 |
$173.66
|
| 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 |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59)
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN,59
|
| Hospital Charge Code |
4670295
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59 W KX)
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN,59,KX
|
| Hospital Charge Code |
4670311
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$321.84
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| 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 |
$173.66
|
| 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 |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59 W KX)
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN,59,KX
|
| Hospital Charge Code |
4670311
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (W/ KX)
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN,KX
|
| Hospital Charge Code |
4670273
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (W/ KX)
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 92626 GN,KX
|
| Hospital Charge Code |
4670273
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$321.84
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| 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 |
$173.66
|
| 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 |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN
|
| Hospital Charge Code |
4670258
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN
|
| Hospital Charge Code |
4670258
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (MOD 59)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN,59
|
| Hospital Charge Code |
4670296
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (MOD 59)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN,59
|
| Hospital Charge Code |
4670296
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN,59,KX
|
| Hospital Charge Code |
4670312
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN,59,KX
|
| Hospital Charge Code |
4670312
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (W/ KX)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN,KX
|
| Hospital Charge Code |
4670274
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (W/ KX)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 92627 GN,KX
|
| Hospital Charge Code |
4670274
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN
|
| Hospital Charge Code |
4670024
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN
|
| Hospital Charge Code |
4670024
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$218.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$176.12
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: CDPHP Commercial |
$383.18
|
| Rate for Payer: CDPHP Medicare |
$176.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$380.80
|
| Rate for Payer: EmblemHealth Medicaid |
$380.80
|
| Rate for Payer: EmblemHealth Medicare |
$161.84
|
| Rate for Payer: EmblemHealth Select Care |
$342.72
|
| Rate for Payer: Fidelis Medicare |
$181.40
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$176.12
|
| Rate for Payer: Humana Medicare |
$176.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.96
|
| 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 |
$184.93
|
| 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 |
$176.12
|
| Rate for Payer: WellCare Medicare |
$261.80
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59)
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59
|
| Hospital Charge Code |
4670288
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$218.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$176.12
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: CDPHP Commercial |
$383.18
|
| Rate for Payer: CDPHP Medicare |
$176.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$380.80
|
| Rate for Payer: EmblemHealth Medicaid |
$380.80
|
| Rate for Payer: EmblemHealth Medicare |
$161.84
|
| Rate for Payer: EmblemHealth Select Care |
$342.72
|
| Rate for Payer: Fidelis Medicare |
$181.40
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$176.12
|
| Rate for Payer: Humana Medicare |
$176.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.96
|
| 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 |
$184.93
|
| 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 |
$176.12
|
| Rate for Payer: WellCare Medicare |
$261.80
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59)
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59
|
| Hospital Charge Code |
4670288
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59 W KX)
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59,KX
|
| Hospital Charge Code |
4670304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59 W KX)
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59,KX
|
| Hospital Charge Code |
4670304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$218.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$176.12
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: CDPHP Commercial |
$383.18
|
| Rate for Payer: CDPHP Medicare |
$176.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$380.80
|
| Rate for Payer: EmblemHealth Medicaid |
$380.80
|
| Rate for Payer: EmblemHealth Medicare |
$161.84
|
| Rate for Payer: EmblemHealth Select Care |
$342.72
|
| Rate for Payer: Fidelis Medicare |
$181.40
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$176.12
|
| Rate for Payer: Humana Medicare |
$176.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.96
|
| 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 |
$184.93
|
| 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 |
$176.12
|
| Rate for Payer: WellCare Medicare |
$261.80
|
|
