|
OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
4850009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna of NY Commercial |
$233.10
|
| Rate for Payer: Aetna of NY Medicare |
$153.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: CDPHP Medicare |
$123.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$266.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$266.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$266.40
|
| Rate for Payer: EmblemHealth Medicaid |
$266.40
|
| Rate for Payer: EmblemHealth Medicare |
$113.22
|
| Rate for Payer: EmblemHealth Select Care |
$239.76
|
| Rate for Payer: Fidelis Medicare |
$133.20
|
| Rate for Payer: Galaxy Health Commercial |
$216.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$233.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$153.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$187.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$49.95
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
| Rate for Payer: WellCare Medicare |
$183.15
|
|
|
OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
5160009
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna of NY Commercial |
$233.10
|
| Rate for Payer: Aetna of NY Medicare |
$153.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: CDPHP Medicare |
$123.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$266.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$266.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$266.40
|
| Rate for Payer: EmblemHealth Medicaid |
$266.40
|
| Rate for Payer: EmblemHealth Medicare |
$113.22
|
| Rate for Payer: EmblemHealth Select Care |
$239.76
|
| Rate for Payer: Fidelis Medicare |
$133.20
|
| Rate for Payer: Galaxy Health Commercial |
$216.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$233.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$153.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$187.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$49.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
| Rate for Payer: WellCare Medicare |
$183.15
|
|
|
OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
4850009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Galaxy Health Commercial |
$216.45
|
|
|
OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
5160007
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Galaxy Health Commercial |
$96.20
|
|
|
OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
5160007
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of NY Commercial |
$103.60
|
| Rate for Payer: Aetna of NY Medicare |
$68.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: CDPHP Medicare |
$54.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$118.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$118.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$118.40
|
| Rate for Payer: EmblemHealth Medicaid |
$118.40
|
| Rate for Payer: EmblemHealth Medicare |
$50.32
|
| Rate for Payer: EmblemHealth Select Care |
$106.56
|
| Rate for Payer: Fidelis Medicare |
$59.20
|
| Rate for Payer: Galaxy Health Commercial |
$96.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.20
|
| Rate for Payer: Humana Medicare |
$59.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$103.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$68.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$83.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$59.20
|
| Rate for Payer: WellCare Medicare |
$81.40
|
|
|
OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
4850007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna of NY Commercial |
$103.60
|
| Rate for Payer: Aetna of NY Medicare |
$68.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: CDPHP Medicare |
$54.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$118.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$118.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$118.40
|
| Rate for Payer: EmblemHealth Medicaid |
$118.40
|
| Rate for Payer: EmblemHealth Medicare |
$50.32
|
| Rate for Payer: EmblemHealth Select Care |
$106.56
|
| Rate for Payer: Fidelis Medicare |
$59.20
|
| Rate for Payer: Galaxy Health Commercial |
$96.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.20
|
| Rate for Payer: Humana Medicare |
$59.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$103.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$68.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$111.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$83.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.20
|
| Rate for Payer: United Healthcare Medicare |
$59.20
|
| Rate for Payer: WellCare Medicare |
$81.40
|
|
|
OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
4850007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Galaxy Health Commercial |
$96.20
|
|
|
OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
4850008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$138.45 |
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Galaxy Health Commercial |
$138.45
|
|
|
OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
5160008
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$170.40 |
| Rate for Payer: Aetna of NY Commercial |
$149.10
|
| Rate for Payer: Aetna of NY Medicare |
$97.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$85.20
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: CDPHP Medicare |
$78.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$170.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$170.40
|
| Rate for Payer: EmblemHealth Medicaid |
$170.40
|
| Rate for Payer: EmblemHealth Medicare |
$72.42
|
| Rate for Payer: EmblemHealth Select Care |
$153.36
|
| Rate for Payer: Fidelis Medicare |
$85.20
|
| Rate for Payer: Galaxy Health Commercial |
$138.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.20
|
| Rate for Payer: Humana Medicare |
$85.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$119.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$85.20
|
| Rate for Payer: WellCare Medicare |
$117.15
|
|
|
OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
5160008
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$138.45 |
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Galaxy Health Commercial |
$138.45
|
|
|
OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
4850008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$170.40 |
| Rate for Payer: Aetna of NY Commercial |
$149.10
|
| Rate for Payer: Aetna of NY Medicare |
$97.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$85.20
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: CDPHP Medicare |
$78.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$170.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$170.40
|
| Rate for Payer: EmblemHealth Medicaid |
$170.40
|
| Rate for Payer: EmblemHealth Medicare |
$72.42
|
| Rate for Payer: EmblemHealth Select Care |
$153.36
|
| Rate for Payer: Fidelis Medicare |
$85.20
|
| Rate for Payer: Galaxy Health Commercial |
$138.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.20
|
| Rate for Payer: Humana Medicare |
$85.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$119.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.95
|
| Rate for Payer: United Healthcare Medicare |
$85.20
|
| Rate for Payer: WellCare Medicare |
$117.15
|
|
|
OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
4850006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna of NY Commercial |
$75.60
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.40
|
| Rate for Payer: EmblemHealth Medicaid |
$86.40
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: EmblemHealth Select Care |
$77.76
|
| Rate for Payer: Fidelis Medicare |
$43.20
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.20
|
| Rate for Payer: Humana Medicare |
$43.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.20
|
| Rate for Payer: United Healthcare Medicare |
$43.20
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
|
OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
5160006
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of NY Commercial |
$75.60
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.40
|
| Rate for Payer: EmblemHealth Medicaid |
$86.40
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: EmblemHealth Select Care |
$77.76
|
| Rate for Payer: Fidelis Medicare |
$43.20
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.20
|
| Rate for Payer: Humana Medicare |
$43.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.20
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
|
OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
4850006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
|
|
OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
5160006
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
|
|
OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
5160005
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
|
|
OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
5160005
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of NY Commercial |
$51.10
|
| Rate for Payer: Aetna of NY Medicare |
$33.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.20
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: CDPHP Medicare |
$27.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.20
|
| Rate for Payer: EmblemHealth Medicaid |
$20.20
|
| Rate for Payer: EmblemHealth Medicare |
$24.82
|
| Rate for Payer: EmblemHealth Select Care |
$52.56
|
| Rate for Payer: Fidelis Medicare |
$29.20
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
| Rate for Payer: Galaxy Health Workers Comp |
$19.80
|
| Rate for Payer: Hamaspik Choice Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.20
|
| Rate for Payer: Humana Medicare |
$29.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.58
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$21.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$43.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$43.43
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.66
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.95
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$29.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$21.21
|
| Rate for Payer: WellCare Medicare |
$40.15
|
|
|
OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
4850004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$342.40 |
| Rate for Payer: Aetna of NY Commercial |
$299.60
|
| Rate for Payer: Aetna of NY Medicare |
$196.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$171.20
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: CDPHP Medicare |
$158.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$342.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$342.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$342.40
|
| Rate for Payer: EmblemHealth Medicaid |
$342.40
|
| Rate for Payer: EmblemHealth Medicare |
$145.52
|
| Rate for Payer: EmblemHealth Select Care |
$308.16
|
| Rate for Payer: Fidelis Medicare |
$171.20
|
| Rate for Payer: Galaxy Health Commercial |
$278.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$171.20
|
| Rate for Payer: Humana Medicare |
$171.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$299.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$196.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$240.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$179.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$64.20
|
| Rate for Payer: United Healthcare Medicare |
$171.20
|
| Rate for Payer: WellCare Medicare |
$235.40
|
|
|
OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
5160004
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$342.40 |
| Rate for Payer: Aetna of NY Commercial |
$299.60
|
| Rate for Payer: Aetna of NY Medicare |
$196.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$171.20
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: CDPHP Medicare |
$158.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$342.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$342.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$342.40
|
| Rate for Payer: EmblemHealth Medicaid |
$342.40
|
| Rate for Payer: EmblemHealth Medicare |
$145.52
|
| Rate for Payer: EmblemHealth Select Care |
$308.16
|
| Rate for Payer: Fidelis Medicare |
$171.20
|
| Rate for Payer: Galaxy Health Commercial |
$278.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$171.20
|
| Rate for Payer: Humana Medicare |
$171.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$299.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$196.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$321.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$240.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$179.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$64.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$171.20
|
| Rate for Payer: WellCare Medicare |
$235.40
|
|
|
OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
5160004
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$278.20 |
| Max. Negotiated Rate |
$278.20 |
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Galaxy Health Commercial |
$278.20
|
|
|
OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
4850004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.20 |
| Max. Negotiated Rate |
$278.20 |
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Galaxy Health Commercial |
$278.20
|
|
|
OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
5160002
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$179.40 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Galaxy Health Commercial |
$179.40
|
|
|
OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
4850002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$179.40 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Galaxy Health Commercial |
$179.40
|
|
|
OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
5160002
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna of NY Commercial |
$193.20
|
| Rate for Payer: Aetna of NY Medicare |
$126.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.40
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: CDPHP Medicare |
$102.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$220.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$220.80
|
| Rate for Payer: EmblemHealth Medicaid |
$220.80
|
| Rate for Payer: EmblemHealth Medicare |
$93.84
|
| Rate for Payer: EmblemHealth Select Care |
$198.72
|
| Rate for Payer: Fidelis Medicare |
$110.40
|
| Rate for Payer: Galaxy Health Commercial |
$179.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.40
|
| Rate for Payer: Humana Medicare |
$110.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$193.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$126.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$155.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$115.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$110.40
|
| Rate for Payer: WellCare Medicare |
$151.80
|
|
|
OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
4850002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna of NY Commercial |
$193.20
|
| Rate for Payer: Aetna of NY Medicare |
$126.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.40
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: CDPHP Medicare |
$102.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$220.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$220.80
|
| Rate for Payer: EmblemHealth Medicaid |
$220.80
|
| Rate for Payer: EmblemHealth Medicare |
$93.84
|
| Rate for Payer: EmblemHealth Select Care |
$198.72
|
| Rate for Payer: Fidelis Medicare |
$110.40
|
| Rate for Payer: Galaxy Health Commercial |
$179.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.40
|
| Rate for Payer: Humana Medicare |
$110.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$193.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$126.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$207.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$155.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$115.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.40
|
| Rate for Payer: United Healthcare Medicare |
$110.40
|
| Rate for Payer: WellCare Medicare |
$151.80
|
|
