|
PSA; FREE
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
4301228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$148.92 |
| Rate for Payer: Aetna of NY Commercial |
$120.25
|
| Rate for Payer: Aetna of NY Medicare |
$85.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$138.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$138.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.45
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$92.50
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: Cash Price |
$138.75
|
| Rate for Payer: CDPHP Commercial |
$148.92
|
| Rate for Payer: CDPHP Medicare |
$68.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.00
|
| Rate for Payer: EmblemHealth Medicaid |
$148.00
|
| Rate for Payer: EmblemHealth Medicare |
$62.90
|
| Rate for Payer: Fidelis Medicare |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$120.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$68.45
|
| Rate for Payer: Humana Medicare |
$68.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$85.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$138.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$71.87
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$138.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.39
|
| Rate for Payer: United Healthcare Commercial |
$138.75
|
| Rate for Payer: United Healthcare Medicare |
$68.45
|
| Rate for Payer: WellCare Medicare |
$101.75
|
|
|
PSEUDOEPHEDRINE HCL 30MG TABS 24 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PT COLD PACKS ONLY
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
4650004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| 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 |
$17.48
|
| 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 |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
PT COLD PACKS ONLY (MOD 59)
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,59
|
| Hospital Charge Code |
4650360
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| 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 |
$17.48
|
| 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 |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
PT COLD PACKS ONLY (MOD 59 W KX)
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
| Hospital Charge Code |
4650412
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| 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 |
$17.48
|
| 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 |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
PT COLD PACKS ONLY (W/ KX)
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97010 GP,KX
|
| Hospital Charge Code |
4650305
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| 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 |
$17.48
|
| 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 |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
4650010
|
|
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
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59)
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59
|
| Hospital Charge Code |
4650362
|
|
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
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59 W KX)
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,59,KX
|
| Hospital Charge Code |
4650414
|
|
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
|
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (W/ KX)
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GP,KX
|
| Hospital Charge Code |
4650307
|
|
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
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
4650302
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$247.94 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$141.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$113.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: CDPHP Commercial |
$247.94
|
| Rate for Payer: CDPHP Medicare |
$113.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$246.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$246.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$246.40
|
| Rate for Payer: EmblemHealth Medicaid |
$246.40
|
| Rate for Payer: EmblemHealth Medicare |
$104.72
|
| Rate for Payer: EmblemHealth Select Care |
$221.76
|
| Rate for Payer: Fidelis Medicare |
$117.38
|
| Rate for Payer: Galaxy Health Commercial |
$200.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$113.96
|
| Rate for Payer: Humana Medicare |
$113.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$141.68
|
| 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 |
$119.66
|
| 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 |
$113.96
|
| Rate for Payer: WellCare Medicare |
$169.40
|
|
|
PT EVAL HIGH COMPLEX 45 MIN (MOD 59)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97163 GP,59
|
| Hospital Charge Code |
4650409
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL HIGH COMPLEX 45 MIN (MOD 59 W KX)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97163 GP,59,KX
|
| Hospital Charge Code |
4650461
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL HIGH COMPLEX 45 MIN (W/ KX)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97163 GP,KX
|
| Hospital Charge Code |
4650357
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
4650300
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$239.89 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$137.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: CDPHP Commercial |
$239.89
|
| Rate for Payer: CDPHP Medicare |
$110.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$238.40
|
| Rate for Payer: EmblemHealth Medicaid |
$238.40
|
| Rate for Payer: EmblemHealth Medicare |
$101.32
|
| Rate for Payer: EmblemHealth Select Care |
$214.56
|
| Rate for Payer: Fidelis Medicare |
$113.57
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.26
|
| Rate for Payer: Humana Medicare |
$110.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$137.08
|
| 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 |
$115.77
|
| 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 |
$110.26
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
PT EVAL LOW COMPLEX 20 MIN (MOD 59)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,59
|
| Hospital Charge Code |
4650407
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: WellCare Medicare |
$199.10
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
|
|
PT EVAL LOW COMPLEX 20 MIN (MOD 59 W KX)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,59,KX
|
| Hospital Charge Code |
4650459
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL LOW COMPLEX 20 MIN (W/ KX)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,KX
|
| Hospital Charge Code |
4650355
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
4650301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$239.89 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$137.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: CDPHP Commercial |
$239.89
|
| Rate for Payer: CDPHP Medicare |
$110.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$238.40
|
| Rate for Payer: EmblemHealth Medicaid |
$238.40
|
| Rate for Payer: EmblemHealth Medicare |
$101.32
|
| Rate for Payer: EmblemHealth Select Care |
$214.56
|
| Rate for Payer: Fidelis Medicare |
$113.57
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.26
|
| Rate for Payer: Humana Medicare |
$110.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$137.08
|
| 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 |
$115.77
|
| 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 |
$110.26
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
PT EVAL MOD COMPLEX 30 MIN (MOD 59)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,59
|
| Hospital Charge Code |
4650408
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL MOD COMPLEX 30 MIN (MOD 59 W KX)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,59,KX
|
| Hospital Charge Code |
4650460
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL MOD COMPLEX 30 MIN (W/ KX)
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,KX
|
| Hospital Charge Code |
4650356
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$291.41 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: CDPHP Commercial |
$291.41
|
| Rate for Payer: CDPHP Medicare |
$133.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
| Rate for Payer: EmblemHealth Medicaid |
$289.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$137.96
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
| Rate for Payer: Humana Medicare |
$133.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| 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 |
$140.64
|
| 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 |
$133.94
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP
|
| Hospital Charge Code |
4650011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: CDPHP Commercial |
$99.02
|
| Rate for Payer: CDPHP Medicare |
$45.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.40
|
| Rate for Payer: EmblemHealth Medicaid |
$98.40
|
| Rate for Payer: EmblemHealth Medicare |
$41.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.56
|
| Rate for Payer: Fidelis Medicare |
$46.88
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.58
|
| 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 |
$47.79
|
| 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 |
$45.51
|
| Rate for Payer: WellCare Medicare |
$67.65
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS (MOD 59)
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP,59
|
| Hospital Charge Code |
4650363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: WellCare Medicare |
$67.65
|
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: CDPHP Commercial |
$99.02
|
| Rate for Payer: CDPHP Medicare |
$45.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.40
|
| Rate for Payer: EmblemHealth Medicaid |
$98.40
|
| Rate for Payer: EmblemHealth Medicare |
$41.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.56
|
| Rate for Payer: Fidelis Medicare |
$46.88
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.58
|
| 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 |
$47.79
|
| 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 |
$45.51
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP,59,KX
|
| Hospital Charge Code |
4650415
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: CDPHP Commercial |
$99.02
|
| Rate for Payer: CDPHP Medicare |
$45.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.40
|
| Rate for Payer: EmblemHealth Medicaid |
$98.40
|
| Rate for Payer: EmblemHealth Medicare |
$41.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.56
|
| Rate for Payer: Fidelis Medicare |
$46.88
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.58
|
| 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 |
$47.79
|
| 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 |
$45.51
|
| Rate for Payer: WellCare Medicare |
$67.65
|
|
