|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (MOD 59 W KX)
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59,KX
|
| Hospital Charge Code |
4670307
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$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 (MOD 59 W KX)
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,59,KX
|
| Hospital Charge Code |
4670307
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (W/ KX)
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,KX
|
| Hospital Charge Code |
4670269
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$525.85 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Cash Price |
$606.75
|
| Rate for Payer: Galaxy Health Commercial |
$525.85
|
|
|
EVAL SPEECH SOUND PROD W/EVAL LANG COMP (W/ KX)
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 92523 GN,KX
|
| Hospital Charge Code |
4670269
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$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
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN
|
| Hospital Charge Code |
4670018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$270.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.20
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$135.20
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.20
|
| Rate for Payer: Humana Medicare |
$135.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$141.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$135.20
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN
|
| Hospital Charge Code |
4670018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59)
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59
|
| Hospital Charge Code |
4670284
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59)
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59
|
| Hospital Charge Code |
4670284
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$270.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.20
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$135.20
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.20
|
| Rate for Payer: Humana Medicare |
$135.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$141.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$135.20
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59 W KX)
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59,KX
|
| Hospital Charge Code |
4670300
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$270.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.20
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$135.20
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.20
|
| Rate for Payer: Humana Medicare |
$135.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$141.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$135.20
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (MOD 59 W KX)
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,59,KX
|
| Hospital Charge Code |
4670300
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (W/ KX)
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,KX
|
| Hospital Charge Code |
4670262
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
EVALUATE ORAL AND PHARYNGEAL SWALLOW FCN (W/ KX)
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 92610 GN,KX
|
| Hospital Charge Code |
4670262
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$270.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.20
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: EmblemHealth Select Care |
$243.36
|
| Rate for Payer: Fidelis Medicare |
$135.20
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.20
|
| Rate for Payer: Humana Medicare |
$135.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$141.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$135.20
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
|
EVALUATE PT USE OF INHALER IPPB
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
4530011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$436.15 |
| Max. Negotiated Rate |
$436.15 |
| Rate for Payer: Cash Price |
$503.25
|
| Rate for Payer: Galaxy Health Commercial |
$436.15
|
|
|
EVALUATE PT USE OF INHALER IPPB
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
4530011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.65 |
| Max. Negotiated Rate |
$536.80 |
| Rate for Payer: Aetna of NY Commercial |
$469.70
|
| Rate for Payer: Aetna of NY Medicare |
$308.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$268.40
|
| Rate for Payer: Cash Price |
$503.25
|
| Rate for Payer: CDPHP Medicare |
$248.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$536.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$536.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$536.80
|
| Rate for Payer: EmblemHealth Medicaid |
$536.80
|
| Rate for Payer: EmblemHealth Medicare |
$228.14
|
| Rate for Payer: EmblemHealth Select Care |
$483.12
|
| Rate for Payer: Fidelis Medicare |
$268.40
|
| Rate for Payer: Galaxy Health Commercial |
$436.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$268.40
|
| Rate for Payer: Humana Medicare |
$268.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$469.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$308.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$503.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$377.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$281.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$100.65
|
| Rate for Payer: United Healthcare Medicare |
$268.40
|
| Rate for Payer: WellCare Medicare |
$369.05
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN
|
| Hospital Charge Code |
4670257
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$375.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$215.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$187.60
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: CDPHP Medicare |
$173.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$375.20
|
| 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 |
$159.46
|
| Rate for Payer: EmblemHealth Select Care |
$337.68
|
| Rate for Payer: Fidelis Medicare |
$187.60
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$187.60
|
| Rate for Payer: Humana Medicare |
$187.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$215.74
|
| 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 |
$196.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$187.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$257.95
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN
|
| Hospital Charge Code |
4670257
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$304.85 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59)
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN,59
|
| Hospital Charge Code |
4670295
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$375.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$215.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$187.60
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: CDPHP Medicare |
$173.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$375.20
|
| 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 |
$159.46
|
| Rate for Payer: EmblemHealth Select Care |
$337.68
|
| Rate for Payer: Fidelis Medicare |
$187.60
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$187.60
|
| Rate for Payer: Humana Medicare |
$187.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$215.74
|
| 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 |
$196.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$187.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$257.95
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59)
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN,59
|
| Hospital Charge Code |
4670295
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$304.85 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59 W KX)
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN,59,KX
|
| Hospital Charge Code |
4670311
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$304.85 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (MOD 59 W KX)
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN,59,KX
|
| Hospital Charge Code |
4670311
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$375.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$215.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$187.60
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: CDPHP Medicare |
$173.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$375.20
|
| 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 |
$159.46
|
| Rate for Payer: EmblemHealth Select Care |
$337.68
|
| Rate for Payer: Fidelis Medicare |
$187.60
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$187.60
|
| Rate for Payer: Humana Medicare |
$187.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$215.74
|
| 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 |
$196.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$187.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$257.95
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (W/ KX)
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN,KX
|
| Hospital Charge Code |
4670273
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$375.20 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$215.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$187.60
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: CDPHP Medicare |
$173.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$375.20
|
| 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 |
$159.46
|
| Rate for Payer: EmblemHealth Select Care |
$337.68
|
| Rate for Payer: Fidelis Medicare |
$187.60
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$187.60
|
| Rate for Payer: Humana Medicare |
$187.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$215.74
|
| 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 |
$196.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$70.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$187.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$257.95
|
|
|
EVALUATION AUDITORY REHAB STATUS 1ST HR (W/ KX)
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 92626 GN,KX
|
| Hospital Charge Code |
4670273
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$304.85 |
| Max. Negotiated Rate |
$304.85 |
| Rate for Payer: Cash Price |
$351.75
|
| Rate for Payer: Galaxy Health Commercial |
$304.85
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN
|
| Hospital Charge Code |
4670258
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN
|
| Hospital Charge Code |
4670258
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.55
|
| Rate for Payer: EmblemHealth Medicaid |
$36.55
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: EmblemHealth Select Care |
$46.80
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Galaxy Health Workers Comp |
$35.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$78.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$78.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.38
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (MOD 59)
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN,59
|
| Hospital Charge Code |
4670296
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.00
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.55
|
| Rate for Payer: EmblemHealth Medicaid |
$36.55
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: EmblemHealth Select Care |
$46.80
|
| Rate for Payer: Fidelis Medicare |
$26.00
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Galaxy Health Workers Comp |
$35.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.00
|
| Rate for Payer: Humana Medicare |
$26.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$78.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$78.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.75
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.38
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
