|
PT EVAL HIGH COMPLEX 45 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97163 GP,59,KX
|
| Hospital Charge Code |
4650461
|
|
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 W KX)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97163 GP,59,KX
|
| Hospital Charge Code |
4650461
|
|
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
|
|
|
PT EVAL HIGH COMPLEX 45 MIN (W/ KX)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97163 GP,KX
|
| Hospital Charge Code |
4650357
|
|
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 (W/ KX)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97163 GP,KX
|
| Hospital Charge Code |
4650357
|
|
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
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
4650300
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$193.70 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
4650300
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$239.89 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$137.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: CDPHP Commercial |
$239.89
|
| Rate for Payer: CDPHP Medicare |
$110.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$238.40
|
| Rate for Payer: EmblemHealth Medicaid |
$238.40
|
| Rate for Payer: EmblemHealth Medicare |
$101.32
|
| Rate for Payer: EmblemHealth Select Care |
$214.56
|
| Rate for Payer: Fidelis Medicare |
$113.57
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.26
|
| Rate for Payer: Humana Medicare |
$110.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$137.08
|
| 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 |
$115.77
|
| 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 |
$110.26
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
PT EVAL LOW COMPLEX 20 MIN (MOD 59)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,59
|
| Hospital Charge Code |
4650407
|
|
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
|
|
|
PT EVAL LOW COMPLEX 20 MIN (MOD 59)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,59
|
| Hospital Charge Code |
4650407
|
|
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 LOW COMPLEX 20 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,59,KX
|
| Hospital Charge Code |
4650459
|
|
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
|
|
|
PT EVAL LOW COMPLEX 20 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,59,KX
|
| Hospital Charge Code |
4650459
|
|
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 LOW COMPLEX 20 MIN (W/ KX)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,KX
|
| Hospital Charge Code |
4650355
|
|
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 LOW COMPLEX 20 MIN (W/ KX)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP,KX
|
| Hospital Charge Code |
4650355
|
|
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
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
4650301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$239.89 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$137.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: CDPHP Commercial |
$239.89
|
| Rate for Payer: CDPHP Medicare |
$110.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$238.40
|
| Rate for Payer: EmblemHealth Medicaid |
$238.40
|
| Rate for Payer: EmblemHealth Medicare |
$101.32
|
| Rate for Payer: EmblemHealth Select Care |
$214.56
|
| Rate for Payer: Fidelis Medicare |
$113.57
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.26
|
| Rate for Payer: Humana Medicare |
$110.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$137.08
|
| 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 |
$115.77
|
| 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 |
$110.26
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
4650301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$193.70 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
|
|
PT EVAL MOD COMPLEX 30 MIN (MOD 59)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,59
|
| Hospital Charge Code |
4650408
|
|
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 MOD COMPLEX 30 MIN (MOD 59)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,59
|
| Hospital Charge Code |
4650408
|
|
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
|
|
|
PT EVAL MOD COMPLEX 30 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,59,KX
|
| Hospital Charge Code |
4650460
|
|
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
|
|
|
PT EVAL MOD COMPLEX 30 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,59,KX
|
| Hospital Charge Code |
4650460
|
|
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 MOD COMPLEX 30 MIN (W/ KX)
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,KX
|
| Hospital Charge Code |
4650356
|
|
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 MOD COMPLEX 30 MIN (W/ KX)
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,KX
|
| Hospital Charge Code |
4650356
|
|
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
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP
|
| Hospital Charge Code |
4650011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP
|
| Hospital Charge Code |
4650011
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: CDPHP Commercial |
$99.02
|
| Rate for Payer: CDPHP Medicare |
$45.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.40
|
| Rate for Payer: EmblemHealth Medicaid |
$98.40
|
| Rate for Payer: EmblemHealth Medicare |
$41.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.56
|
| Rate for Payer: Fidelis Medicare |
$46.88
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.58
|
| 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 |
$47.79
|
| 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 |
$45.51
|
| Rate for Payer: WellCare Medicare |
$67.65
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP,59
|
| Hospital Charge Code |
4650363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP,59
|
| Hospital Charge Code |
4650363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: CDPHP Commercial |
$99.02
|
| Rate for Payer: CDPHP Medicare |
$45.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.40
|
| Rate for Payer: EmblemHealth Medicaid |
$98.40
|
| Rate for Payer: EmblemHealth Medicare |
$41.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.56
|
| Rate for Payer: Fidelis Medicare |
$46.88
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.58
|
| 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 |
$47.79
|
| 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 |
$45.51
|
| Rate for Payer: WellCare Medicare |
$67.65
|
|
|
PT GAIT TRAINING THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 97116 GP,59,KX
|
| Hospital Charge Code |
4650415
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$92.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: CDPHP Commercial |
$99.02
|
| Rate for Payer: CDPHP Medicare |
$45.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$98.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.40
|
| Rate for Payer: EmblemHealth Medicaid |
$98.40
|
| Rate for Payer: EmblemHealth Medicare |
$41.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.56
|
| Rate for Payer: Fidelis Medicare |
$46.88
|
| Rate for Payer: Galaxy Health Commercial |
$79.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.58
|
| 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 |
$47.79
|
| 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 |
$45.51
|
| Rate for Payer: WellCare Medicare |
$67.65
|
|
