|
EUFLEXXA 20 MG/2 ML SYRINGE 2 mL, 2 mL
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
4401429
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.58 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Aetna of NY Medicare |
$563.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$489.60
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: CDPHP Medicare |
$452.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$105.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$979.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$979.20
|
| Rate for Payer: EmblemHealth Medicaid |
$979.20
|
| Rate for Payer: EmblemHealth Medicare |
$416.16
|
| Rate for Payer: EmblemHealth Select Care |
$105.58
|
| Rate for Payer: Fidelis Medicare |
$489.60
|
| Rate for Payer: Galaxy Health Commercial |
$795.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$489.60
|
| Rate for Payer: Humana Medicare |
$489.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$216.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.60
|
| Rate for Payer: United Healthcare Commercial |
$216.84
|
| Rate for Payer: United Healthcare Medicare |
$489.60
|
| Rate for Payer: WellCare Medicare |
$673.20
|
|
|
EVAC SU HEMATOMA
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4856701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$285.60
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$285.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
EVAC SU HEMATOMA
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4856701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4600087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
4600087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN
|
| Hospital Charge Code |
4670023
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.60
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: EmblemHealth Select Care |
$164.88
|
| Rate for Payer: Fidelis Medicare |
$91.60
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.60
|
| Rate for Payer: Humana Medicare |
$91.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$34.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$91.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN
|
| Hospital Charge Code |
4670023
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$148.85 |
| Max. Negotiated Rate |
$148.85 |
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59)
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN,59
|
| Hospital Charge Code |
4670287
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.60
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: EmblemHealth Select Care |
$164.88
|
| Rate for Payer: Fidelis Medicare |
$91.60
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.60
|
| Rate for Payer: Humana Medicare |
$91.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$34.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$91.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59)
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN,59
|
| Hospital Charge Code |
4670287
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$148.85 |
| Max. Negotiated Rate |
$148.85 |
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59 W KX)
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN,59,KX
|
| Hospital Charge Code |
4670303
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$148.85 |
| Max. Negotiated Rate |
$148.85 |
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (MOD 59 W KX)
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN,59,KX
|
| Hospital Charge Code |
4670303
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.60
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: EmblemHealth Select Care |
$164.88
|
| Rate for Payer: Fidelis Medicare |
$91.60
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.60
|
| Rate for Payer: Humana Medicare |
$91.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$34.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$91.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (W/ KX)
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN,KX
|
| Hospital Charge Code |
4670265
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$148.85 |
| Max. Negotiated Rate |
$148.85 |
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
|
|
EVAL-PRESCRIPT VOICE PROSTHETI (W/ KX)
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS 92597 GN,KX
|
| Hospital Charge Code |
4670265
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$105.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$91.60
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: Cash Price |
$171.75
|
| Rate for Payer: CDPHP Medicare |
$84.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$183.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$77.86
|
| Rate for Payer: EmblemHealth Select Care |
$164.88
|
| Rate for Payer: Fidelis Medicare |
$91.60
|
| Rate for Payer: Galaxy Health Commercial |
$148.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$91.60
|
| Rate for Payer: Humana Medicare |
$91.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$105.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$96.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$34.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$91.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$125.95
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN
|
| Hospital Charge Code |
4670022
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$160.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$160.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$160.00
|
| Rate for Payer: Humana Medicare |
$160.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$168.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$160.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN
|
| Hospital Charge Code |
4670022
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59
|
| Hospital Charge Code |
4670286
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$160.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$160.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$160.00
|
| Rate for Payer: Humana Medicare |
$160.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$168.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$160.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59
|
| Hospital Charge Code |
4670286
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59 W KX)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59,KX
|
| Hospital Charge Code |
4670302
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (MOD 59 W KX)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,59,KX
|
| Hospital Charge Code |
4670302
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$160.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$160.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$160.00
|
| Rate for Payer: Humana Medicare |
$160.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$168.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$160.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (W/ KX)
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,KX
|
| Hospital Charge Code |
4670264
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$184.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$160.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: CDPHP Medicare |
$148.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$320.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$136.00
|
| Rate for Payer: EmblemHealth Select Care |
$288.00
|
| Rate for Payer: Fidelis Medicare |
$160.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$160.00
|
| Rate for Payer: Humana Medicare |
$160.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$184.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$168.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$160.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$220.00
|
|
|
EVAL SPEECH SOUND PRODUCT ARTICULATION (W/ KX)
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 92522 GN,KX
|
| Hospital Charge Code |
4670264
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Galaxy Health Commercial |
$260.00
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN
|
| Hospital Charge Code |
4670083
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$647.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$372.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$323.60
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: CDPHP Medicare |
$299.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$275.06
|
| Rate for Payer: EmblemHealth Select Care |
$582.48
|
| Rate for Payer: Fidelis Medicare |
$323.60
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$323.60
|
| Rate for Payer: Humana Medicare |
$323.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$372.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$339.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$323.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$444.95
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN
|
| Hospital Charge Code |
4670083
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (MOD 59)
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59
|
| Hospital Charge Code |
4670291
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (MOD 59)
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59
|
| Hospital Charge Code |
4670291
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$647.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$372.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$323.60
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: CDPHP Medicare |
$299.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$647.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.19
|
| Rate for Payer: EmblemHealth Medicaid |
$146.19
|
| Rate for Payer: EmblemHealth Medicare |
$275.06
|
| Rate for Payer: EmblemHealth Select Care |
$582.48
|
| Rate for Payer: Fidelis Medicare |
$323.60
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$323.60
|
| Rate for Payer: Humana Medicare |
$323.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$372.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$153.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$339.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$323.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$444.95
|
|
