|
ECONOMY COTTON STOCKINETTE 5"
|
Facility
|
OP
|
$13.39
|
|
| Hospital Charge Code |
4471422
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.36
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.36
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$5.36
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
ECUP TEST
|
Facility
|
IP
|
$59.74
|
|
| Hospital Charge Code |
4304882
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Galaxy Health Commercial |
$38.83
|
|
|
ECUP TEST
|
Facility
|
OP
|
$59.74
|
|
| Hospital Charge Code |
4304882
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$47.79 |
| Rate for Payer: Aetna of NY Commercial |
$41.82
|
| Rate for Payer: Aetna of NY Medicare |
$27.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.90
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: CDPHP Medicare |
$22.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.79
|
| Rate for Payer: EmblemHealth Medicaid |
$47.79
|
| Rate for Payer: EmblemHealth Medicare |
$20.31
|
| Rate for Payer: EmblemHealth Select Care |
$43.01
|
| Rate for Payer: Fidelis Medicare |
$23.90
|
| Rate for Payer: Galaxy Health Commercial |
$38.83
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.90
|
| Rate for Payer: Humana Medicare |
$23.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.82
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.96
|
| Rate for Payer: United Healthcare Medicare |
$23.90
|
| Rate for Payer: WellCare Medicare |
$32.86
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480013
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of NY Commercial |
$126.75
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$78.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$126.75
|
| Rate for Payer: Fidelis Medicare |
$78.00
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$78.00
|
| Rate for Payer: Humana Medicare |
$78.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$81.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$78.00
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480086
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480086
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of NY Commercial |
$126.75
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$78.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$136.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$126.75
|
| Rate for Payer: Fidelis Medicare |
$78.00
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$78.00
|
| Rate for Payer: Humana Medicare |
$78.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$126.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$146.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$109.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$81.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$78.00
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
EKG 12 LEAD; TRACING ONLY
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
4480013
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
ELBOW ORTHOTIC (EO), WITHOUT JOINTS, CUSTOM FABRICATED
|
Facility
|
OP
|
$826.06
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
4690162
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.91 |
| Max. Negotiated Rate |
$660.85 |
| Rate for Payer: Aetna of NY Commercial |
$578.24
|
| Rate for Payer: Aetna of NY Medicare |
$379.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$330.42
|
| Rate for Payer: Cash Price |
$619.54
|
| Rate for Payer: CDPHP Medicare |
$305.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$413.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$660.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$660.85
|
| Rate for Payer: EmblemHealth Medicaid |
$660.85
|
| Rate for Payer: EmblemHealth Medicare |
$280.86
|
| Rate for Payer: EmblemHealth Select Care |
$413.03
|
| Rate for Payer: Fidelis Medicare |
$330.42
|
| Rate for Payer: Galaxy Health Commercial |
$536.94
|
| Rate for Payer: Hamaspik Choice Medicare |
$330.42
|
| Rate for Payer: Humana Medicare |
$330.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$578.24
|
| Rate for Payer: Local 1199SEIU Medicare |
$379.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$619.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$465.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$346.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$123.91
|
| Rate for Payer: United Healthcare Medicare |
$330.42
|
| Rate for Payer: WellCare Medicare |
$454.33
|
|
|
ELBOW ORTHOTIC (EO), WITHOUT JOINTS, CUSTOM FABRICATED
|
Facility
|
IP
|
$826.06
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
4690162
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$371.73 |
| Max. Negotiated Rate |
$536.94 |
| Rate for Payer: Cash Price |
$619.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$413.03
|
| Rate for Payer: EmblemHealth Select Care |
$413.03
|
| Rate for Payer: Galaxy Health Commercial |
$536.94
|
| Rate for Payer: Multiplan Commercial |
$371.73
|
| Rate for Payer: WellCare Medicare |
$454.33
|
|
|
ELECTRICAL STIMULATION EA 15 MINS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
4650080
|
|
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
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
4650080
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
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 |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| 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 |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| 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 |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| 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
|
OP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP
|
| Hospital Charge Code |
4650077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: CDPHP Medicare |
$40.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$36.77
|
| Rate for Payer: EmblemHealth Select Care |
$77.87
|
| Rate for Payer: Fidelis Medicare |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.26
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$59.48
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS
|
Facility
|
IP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP
|
| Hospital Charge Code |
4650077
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
IP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP,59
|
| Hospital Charge Code |
4650392
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
OP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP,59
|
| Hospital Charge Code |
4650392
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: CDPHP Medicare |
$40.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$36.77
|
| Rate for Payer: EmblemHealth Select Care |
$77.87
|
| Rate for Payer: Fidelis Medicare |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.26
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$59.48
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
OP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP,59,KX
|
| Hospital Charge Code |
4650444
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: CDPHP Medicare |
$40.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$36.77
|
| Rate for Payer: EmblemHealth Select Care |
$77.87
|
| Rate for Payer: Fidelis Medicare |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.26
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$59.48
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
IP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP,59,KX
|
| Hospital Charge Code |
4650444
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
IP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP,KX
|
| Hospital Charge Code |
4650340
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
|
|
ELECTRIC STIMULATION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
OP
|
$108.15
|
|
|
Service Code
|
HCPCS 97014 GP,KX
|
| Hospital Charge Code |
4650340
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: Cash Price |
$81.11
|
| Rate for Payer: CDPHP Medicare |
$40.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$36.77
|
| Rate for Payer: EmblemHealth Select Care |
$77.87
|
| Rate for Payer: Fidelis Medicare |
$43.26
|
| Rate for Payer: Galaxy Health Commercial |
$70.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.26
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$59.48
|
|
