PROXIMAL REVISION KIT
|
Facility
|
IP
|
$1,139.00
|
|
Hospital Charge Code |
4471636
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$740.35 |
Max. Negotiated Rate |
$740.35 |
Rate for Payer: Cash Price |
$854.25
|
Rate for Payer: Galaxy Health Commercial |
$740.35
|
|
PSA; FREE
|
Facility
|
OP
|
$185.00
|
|
Service Code
|
HCPCS 84154
|
Hospital Charge Code |
4301228
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$18.39 |
Max. Negotiated Rate |
$148.92 |
Rate for Payer: Aetna of NY Commercial |
$120.25
|
Rate for Payer: Aetna of NY Medicare |
$85.10
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$138.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$138.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.45
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$92.50
|
Rate for Payer: Cash Price |
$138.75
|
Rate for Payer: Cash Price |
$138.75
|
Rate for Payer: CDPHP Commercial |
$148.92
|
Rate for Payer: CDPHP Medicare |
$68.45
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$111.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.00
|
Rate for Payer: EmblemHealth Medicaid |
$148.00
|
Rate for Payer: EmblemHealth Medicare |
$62.90
|
Rate for Payer: EmblemHealth Select Care |
$111.00
|
Rate for Payer: Fidelis Medicare |
$70.50
|
Rate for Payer: Galaxy Health Commercial |
$120.25
|
Rate for Payer: Hamaspik Choice Medicare |
$68.45
|
Rate for Payer: Humana Medicare |
$68.45
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$120.25
|
Rate for Payer: Local 1199SEIU Medicare |
$85.10
|
Rate for Payer: MVP Health Care of NY Commercial |
$138.75
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$104.16
|
Rate for Payer: MVP Health Care of NY Medicare |
$71.87
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$138.75
|
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.39
|
Rate for Payer: United Healthcare Commercial |
$138.75
|
Rate for Payer: United Healthcare Medicare |
$68.45
|
Rate for Payer: WellCare Medicare |
$101.75
|
|
PSA; FREE
|
Facility
|
IP
|
$185.00
|
|
Service Code
|
HCPCS 84154
|
Hospital Charge Code |
4301228
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$120.25 |
Max. Negotiated Rate |
$120.25 |
Rate for Payer: Cash Price |
$138.75
|
Rate for Payer: Galaxy Health Commercial |
$120.25
|
|
PSEUDOEPHEDRINE HCL 30MG TABS 24 EA
|
Facility
|
IP
|
$6.18
|
|
Service Code
|
NDC 00904505324
|
Hospital Charge Code |
4400725
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$3.40 |
Max. Negotiated Rate |
$4.02 |
Rate for Payer: Cash Price |
$4.64
|
Rate for Payer: Galaxy Health Commercial |
$4.02
|
Rate for Payer: WellCare Medicare |
$3.40
|
|
PSEUDOEPHEDRINE HCL 30MG TABS 24 EA
|
Facility
|
OP
|
$6.18
|
|
Service Code
|
NDC 00904505324
|
Hospital Charge Code |
4400725
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$2.10 |
Max. Negotiated Rate |
$4.97 |
Rate for Payer: Aetna of NY Commercial |
$4.33
|
Rate for Payer: Aetna of NY Medicare |
$2.84
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
Rate for Payer: Cash Price |
$4.64
|
Rate for Payer: CDPHP Commercial |
$4.97
|
Rate for Payer: CDPHP Medicare |
$2.29
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
Rate for Payer: EmblemHealth Medicaid |
$4.94
|
Rate for Payer: EmblemHealth Medicare |
$2.10
|
Rate for Payer: EmblemHealth Select Care |
$4.45
|
Rate for Payer: Fidelis Medicare |
$2.36
|
Rate for Payer: Galaxy Health Commercial |
$4.02
|
Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
Rate for Payer: Humana Medicare |
$2.29
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
Rate for Payer: United Healthcare Medicare |
$2.29
|
Rate for Payer: WellCare Medicare |
$3.40
|
|
PT COLD PACKS ONLY
|
Facility
|
OP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP
|
Hospital Charge Code |
4650004
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$15.30 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$20.70
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: CDPHP Commercial |
$36.22
|
Rate for Payer: CDPHP Medicare |
$16.65
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
Rate for Payer: EmblemHealth Medicaid |
$36.00
|
Rate for Payer: EmblemHealth Medicare |
$15.30
|
Rate for Payer: EmblemHealth Select Care |
$32.40
|
Rate for Payer: Fidelis Medicare |
$17.15
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
Rate for Payer: Humana Medicare |
$16.65
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$16.65
|
Rate for Payer: WellCare Medicare |
$24.75
|
|
PT COLD PACKS ONLY
|
Facility
|
IP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP
|
Hospital Charge Code |
4650004
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
PT COLD PACKS ONLY (MOD 59)
|
Facility
|
OP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP,59
|
Hospital Charge Code |
4650360
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$15.30 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$20.70
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: CDPHP Commercial |
$36.22
|
Rate for Payer: CDPHP Medicare |
$16.65
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
Rate for Payer: EmblemHealth Medicaid |
$36.00
|
Rate for Payer: EmblemHealth Medicare |
$15.30
|
Rate for Payer: EmblemHealth Select Care |
$32.40
|
Rate for Payer: Fidelis Medicare |
$17.15
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
Rate for Payer: Humana Medicare |
$16.65
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$16.65
|
Rate for Payer: WellCare Medicare |
$24.75
|
|
PT COLD PACKS ONLY (MOD 59)
|
Facility
|
IP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP,59
|
Hospital Charge Code |
4650360
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
PT COLD PACKS ONLY (MOD 59 W KX)
|
Facility
|
IP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
Hospital Charge Code |
4650412
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
PT COLD PACKS ONLY (MOD 59 W KX)
|
Facility
|
OP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP,59,KX
|
Hospital Charge Code |
4650412
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$15.30 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$20.70
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: CDPHP Commercial |
$36.22
|
Rate for Payer: CDPHP Medicare |
$16.65
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
Rate for Payer: EmblemHealth Medicaid |
$36.00
|
Rate for Payer: EmblemHealth Medicare |
$15.30
|
Rate for Payer: EmblemHealth Select Care |
$32.40
|
Rate for Payer: Fidelis Medicare |
$17.15
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
Rate for Payer: Humana Medicare |
$16.65
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$16.65
|
Rate for Payer: WellCare Medicare |
$24.75
|
|
PT COLD PACKS ONLY (W/ KX)
|
Facility
|
IP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP,KX
|
Hospital Charge Code |
4650305
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$29.25 |
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
|
PT COLD PACKS ONLY (W/ KX)
|
Facility
|
OP
|
$45.00
|
|
Service Code
|
HCPCS 97010 GP,KX
|
Hospital Charge Code |
4650305
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$15.30 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$20.70
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: Cash Price |
$33.75
|
Rate for Payer: CDPHP Commercial |
$36.22
|
Rate for Payer: CDPHP Medicare |
$16.65
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
Rate for Payer: EmblemHealth Medicaid |
$36.00
|
Rate for Payer: EmblemHealth Medicare |
$15.30
|
Rate for Payer: EmblemHealth Select Care |
$32.40
|
Rate for Payer: Fidelis Medicare |
$17.15
|
Rate for Payer: Galaxy Health Commercial |
$29.25
|
Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
Rate for Payer: Humana Medicare |
$16.65
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$16.65
|
Rate for Payer: WellCare Medicare |
$24.75
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND
|
Facility
|
OP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP
|
Hospital Charge Code |
4650010
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$17.68 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$23.92
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: CDPHP Commercial |
$41.86
|
Rate for Payer: CDPHP Medicare |
$19.24
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
Rate for Payer: EmblemHealth Medicaid |
$41.60
|
Rate for Payer: EmblemHealth Medicare |
$17.68
|
Rate for Payer: EmblemHealth Select Care |
$37.44
|
Rate for Payer: Fidelis Medicare |
$19.82
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
Rate for Payer: Humana Medicare |
$19.24
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$19.24
|
Rate for Payer: WellCare Medicare |
$28.60
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND
|
Facility
|
IP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP
|
Hospital Charge Code |
4650010
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$33.80 |
Max. Negotiated Rate |
$33.80 |
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59)
|
Facility
|
IP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP,59
|
Hospital Charge Code |
4650362
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$33.80 |
Max. Negotiated Rate |
$33.80 |
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59)
|
Facility
|
OP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP,59
|
Hospital Charge Code |
4650362
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$17.68 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$23.92
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: CDPHP Commercial |
$41.86
|
Rate for Payer: CDPHP Medicare |
$19.24
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
Rate for Payer: EmblemHealth Medicaid |
$41.60
|
Rate for Payer: EmblemHealth Medicare |
$17.68
|
Rate for Payer: EmblemHealth Select Care |
$37.44
|
Rate for Payer: Fidelis Medicare |
$19.82
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
Rate for Payer: Humana Medicare |
$19.24
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$19.24
|
Rate for Payer: WellCare Medicare |
$28.60
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59 W KX)
|
Facility
|
OP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP,59,KX
|
Hospital Charge Code |
4650414
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$17.68 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$23.92
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: CDPHP Commercial |
$41.86
|
Rate for Payer: CDPHP Medicare |
$19.24
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
Rate for Payer: EmblemHealth Medicaid |
$41.60
|
Rate for Payer: EmblemHealth Medicare |
$17.68
|
Rate for Payer: EmblemHealth Select Care |
$37.44
|
Rate for Payer: Fidelis Medicare |
$19.82
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
Rate for Payer: Humana Medicare |
$19.24
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$19.24
|
Rate for Payer: WellCare Medicare |
$28.60
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (MOD 59 W KX)
|
Facility
|
IP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP,59,KX
|
Hospital Charge Code |
4650414
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$33.80 |
Max. Negotiated Rate |
$33.80 |
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (W/ KX)
|
Facility
|
IP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP,KX
|
Hospital Charge Code |
4650307
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$33.80 |
Max. Negotiated Rate |
$33.80 |
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
PT ELECTRIC STIM/UNATTEND OTHER THAN WND (W/ KX)
|
Facility
|
OP
|
$52.00
|
|
Service Code
|
HCPCS 97032 GP,KX
|
Hospital Charge Code |
4650307
|
Hospital Revenue Code
|
420
|
Min. Negotiated Rate |
$17.68 |
Max. Negotiated Rate |
$179.00 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$23.92
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: Cash Price |
$39.00
|
Rate for Payer: CDPHP Commercial |
$41.86
|
Rate for Payer: CDPHP Medicare |
$19.24
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
Rate for Payer: EmblemHealth Medicaid |
$41.60
|
Rate for Payer: EmblemHealth Medicare |
$17.68
|
Rate for Payer: EmblemHealth Select Care |
$37.44
|
Rate for Payer: Fidelis Medicare |
$19.82
|
Rate for Payer: Galaxy Health Commercial |
$33.80
|
Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
Rate for Payer: Humana Medicare |
$19.24
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$19.24
|
Rate for Payer: WellCare Medicare |
$28.60
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
IP
|
$308.00
|
|
Service Code
|
HCPCS 97163 GP
|
Hospital Charge Code |
4650302
|
Hospital Revenue Code
|
424
|
Min. Negotiated Rate |
$200.20 |
Max. Negotiated Rate |
$200.20 |
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: Galaxy Health Commercial |
$200.20
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
OP
|
$308.00
|
|
Service Code
|
HCPCS 97163 GP
|
Hospital Charge Code |
4650302
|
Hospital Revenue Code
|
424
|
Min. Negotiated Rate |
$104.72 |
Max. Negotiated Rate |
$247.94 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$141.68
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$231.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$231.00
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$113.96
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: CDPHP Commercial |
$247.94
|
Rate for Payer: CDPHP Medicare |
$113.96
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$246.40
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$246.40
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$246.40
|
Rate for Payer: EmblemHealth Medicaid |
$246.40
|
Rate for Payer: EmblemHealth Medicare |
$104.72
|
Rate for Payer: EmblemHealth Select Care |
$221.76
|
Rate for Payer: Fidelis Medicare |
$117.38
|
Rate for Payer: Galaxy Health Commercial |
$200.20
|
Rate for Payer: Hamaspik Choice Medicare |
$113.96
|
Rate for Payer: Humana Medicare |
$113.96
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$141.68
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$119.66
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$113.96
|
Rate for Payer: WellCare Medicare |
$169.40
|
|
PT EVAL HIGH COMPLEX 45 MIN (MOD 59)
|
Facility
|
OP
|
$362.00
|
|
Service Code
|
HCPCS 97163 GP,59
|
Hospital Charge Code |
4650409
|
Hospital Revenue Code
|
424
|
Min. Negotiated Rate |
$108.00 |
Max. Negotiated Rate |
$291.41 |
Rate for Payer: Aetna of NY Commercial |
$112.00
|
Rate for Payer: Aetna of NY Medicare |
$166.52
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$271.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$271.50
|
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.94
|
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
Rate for Payer: Cash Price |
$271.50
|
Rate for Payer: Cash Price |
$271.50
|
Rate for Payer: Cash Price |
$271.50
|
Rate for Payer: CDPHP Commercial |
$291.41
|
Rate for Payer: CDPHP Medicare |
$133.94
|
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$289.60
|
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$289.60
|
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$289.60
|
Rate for Payer: EmblemHealth Medicaid |
$289.60
|
Rate for Payer: EmblemHealth Medicare |
$123.08
|
Rate for Payer: EmblemHealth Select Care |
$260.64
|
Rate for Payer: Fidelis Medicare |
$137.96
|
Rate for Payer: Galaxy Health Commercial |
$235.30
|
Rate for Payer: Hamaspik Choice Medicare |
$133.94
|
Rate for Payer: Humana Medicare |
$133.94
|
Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
Rate for Payer: MVP Health Care of NY Medicare |
$140.64
|
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
Rate for Payer: United Healthcare Commercial |
$156.00
|
Rate for Payer: United Healthcare Medicare |
$133.94
|
Rate for Payer: WellCare Medicare |
$199.10
|
|
PT EVAL HIGH COMPLEX 45 MIN (MOD 59)
|
Facility
|
IP
|
$362.00
|
|
Service Code
|
HCPCS 97163 GP,59
|
Hospital Charge Code |
4650409
|
Hospital Revenue Code
|
424
|
Min. Negotiated Rate |
$235.30 |
Max. Negotiated Rate |
$235.30 |
Rate for Payer: Cash Price |
$271.50
|
Rate for Payer: Galaxy Health Commercial |
$235.30
|
|