|
EVALUATION AUDITORY REHAB STATUS EA 15 MIN (MOD 59)
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN,59
|
| Hospital Charge Code |
4670296
|
|
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 (MOD 59 W KX)
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN,59,KX
|
| Hospital Charge Code |
4670312
|
|
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 W KX)
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN,59,KX
|
| Hospital Charge Code |
4670312
|
|
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 (W/ KX)
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN,KX
|
| Hospital Charge Code |
4670274
|
|
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 (W/ KX)
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 92627 GN,KX
|
| Hospital Charge Code |
4670274
|
|
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 SPEECH FLUENCY STUTTERING
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN
|
| Hospital Charge Code |
4670024
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$218.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$190.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: CDPHP Medicare |
$176.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$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 |
$161.84
|
| Rate for Payer: EmblemHealth Select Care |
$342.72
|
| Rate for Payer: Fidelis Medicare |
$190.40
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$190.40
|
| Rate for Payer: Humana Medicare |
$190.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.96
|
| 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 |
$199.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$190.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$261.80
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN
|
| Hospital Charge Code |
4670024
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59)
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59
|
| Hospital Charge Code |
4670288
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$218.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$190.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: CDPHP Medicare |
$176.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$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 |
$161.84
|
| Rate for Payer: EmblemHealth Select Care |
$342.72
|
| Rate for Payer: Fidelis Medicare |
$190.40
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$190.40
|
| Rate for Payer: Humana Medicare |
$190.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.96
|
| 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 |
$199.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$190.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$261.80
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59)
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59
|
| Hospital Charge Code |
4670288
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59 W KX)
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59,KX
|
| Hospital Charge Code |
4670304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$218.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$190.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: CDPHP Medicare |
$176.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$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 |
$161.84
|
| Rate for Payer: EmblemHealth Select Care |
$342.72
|
| Rate for Payer: Fidelis Medicare |
$190.40
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$190.40
|
| Rate for Payer: Humana Medicare |
$190.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.96
|
| 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 |
$199.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$190.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$261.80
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (MOD 59 W KX)
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,59,KX
|
| Hospital Charge Code |
4670304
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (W/ KX)
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,KX
|
| Hospital Charge Code |
4670266
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
|
|
EVALUATION SPEECH FLUENCY STUTTERING (W/ KX)
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 92521 GN,KX
|
| Hospital Charge Code |
4670266
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$218.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$190.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: CDPHP Medicare |
$176.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$380.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$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 |
$161.84
|
| Rate for Payer: EmblemHealth Select Care |
$342.72
|
| Rate for Payer: Fidelis Medicare |
$190.40
|
| Rate for Payer: Galaxy Health Commercial |
$309.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$143.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$190.40
|
| Rate for Payer: Humana Medicare |
$190.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$218.96
|
| 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 |
$199.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$71.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$190.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.50
|
| Rate for Payer: WellCare Medicare |
$261.80
|
|
|
EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
4690272
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna of NY Commercial |
$409.50
|
| Rate for Payer: Aetna of NY Medicare |
$269.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$234.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: CDPHP Medicare |
$216.45
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$468.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$468.00
|
| Rate for Payer: EmblemHealth Medicaid |
$468.00
|
| Rate for Payer: EmblemHealth Medicare |
$198.90
|
| Rate for Payer: EmblemHealth Select Care |
$292.50
|
| Rate for Payer: Fidelis Medicare |
$234.00
|
| Rate for Payer: Galaxy Health Commercial |
$380.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$234.00
|
| Rate for Payer: Humana Medicare |
$234.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$409.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$269.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$438.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$329.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$245.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$87.75
|
| Rate for Payer: United Healthcare Medicare |
$234.00
|
| Rate for Payer: WellCare Medicare |
$321.75
|
|
|
EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS L3763
|
| Hospital Charge Code |
4690272
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.25 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.50
|
| Rate for Payer: EmblemHealth Select Care |
$292.50
|
| Rate for Payer: Galaxy Health Commercial |
$380.25
|
| Rate for Payer: Multiplan Commercial |
$263.25
|
| Rate for Payer: WellCare Medicare |
$321.75
|
|
|
EXAM SYNOVIAL FLUID CRYSTALS
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
4008906
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
EXAM SYNOVIAL FLUID CRYSTALS
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
4008906
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: Aetna of NY Commercial |
$14.30
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.80
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$13.20
|
| Rate for Payer: Fidelis Medicare |
$8.80
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.80
|
| Rate for Payer: Humana Medicare |
$8.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$16.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$8.80
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
EXC BENIGN LES TRUNK/ARM/LEG; 1.1-2.0CM
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
4601187
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| 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 |
$911.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
EXC BENIGN LES TRUNK/ARM/LEG; 1.1-2.0CM
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
4601187
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
EXC BEN LES T/A/L; 0.6-1.0CM
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
4850300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.90 |
| Max. Negotiated Rate |
$996.80 |
| Rate for Payer: Aetna of NY Commercial |
$872.20
|
| Rate for Payer: Aetna of NY Medicare |
$573.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$498.40
|
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: CDPHP Medicare |
$461.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$996.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$996.80
|
| Rate for Payer: EmblemHealth Medicaid |
$996.80
|
| Rate for Payer: EmblemHealth Medicare |
$423.64
|
| Rate for Payer: EmblemHealth Select Care |
$897.12
|
| Rate for Payer: Fidelis Medicare |
$498.40
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$498.40
|
| Rate for Payer: Humana Medicare |
$498.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$872.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$573.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$934.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$701.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$523.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.90
|
| Rate for Payer: United Healthcare Medicare |
$498.40
|
| Rate for Payer: WellCare Medicare |
$685.30
|
|
|
EXC BEN LES T/A/L; 0.6-1.0CM
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
4850300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.90 |
| Max. Negotiated Rate |
$809.90 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Galaxy Health Commercial |
$809.90
|
|
|
EXC BEN LES T/A/L; 1.1-2.0CM
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
4850125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
|
EXC BEN LES T/A/L; 1.1-2.0CM
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
4850125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,519.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,562.40
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,519.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,627.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,221.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
EXC BEN LES T/A/L; 2.1-3.0CM
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
4850124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,519.00
|
| Rate for Payer: Aetna of NY Medicare |
$998.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: CDPHP Medicare |
$802.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,736.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,736.00
|
| Rate for Payer: EmblemHealth Medicare |
$737.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,562.40
|
| Rate for Payer: Fidelis Medicare |
$868.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$868.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,519.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$998.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,627.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,221.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$911.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$325.50
|
| Rate for Payer: United Healthcare Medicare |
$868.00
|
| Rate for Payer: WellCare Medicare |
$1,193.50
|
|
|
EXC BEN LES T/A/L; 2.1-3.0CM
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
4850124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$1,410.50 |
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,410.50
|
|
