|
PT NON WND ELECT STIM (W/ KX)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP,KX
|
| Hospital Charge Code |
4650354
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
|
|
PT NON WND ELECT STIM (W/ KX)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP,KX
|
| Hospital Charge Code |
4650354
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Commercial |
$39.44
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$18.67
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.13
|
| Rate for Payer: Humana Medicare |
$18.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| 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 |
$19.04
|
| 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 |
$18.13
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
P T ONE HALF HOUR
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4650058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Commercial |
$109.48
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
| Rate for Payer: EmblemHealth Medicaid |
$108.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$51.83
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
| Rate for Payer: Humana Medicare |
$50.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| 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 |
$52.84
|
| 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 |
$50.32
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
P T ONE HALF HOUR
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4650058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
P T ONE HOUR UP TO TWO HOURS
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4650059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
P T ONE HOUR UP TO TWO HOURS
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4650059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Commercial |
$109.48
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.80
|
| Rate for Payer: EmblemHealth Medicaid |
$108.80
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$51.83
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
| Rate for Payer: Humana Medicare |
$50.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| 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 |
$52.84
|
| 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 |
$50.32
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 97164 GP
|
| Hospital Charge Code |
4650303
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Galaxy Health Commercial |
$133.90
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 97164 GP
|
| Hospital Charge Code |
4650303
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$94.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$154.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$154.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$76.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: CDPHP Commercial |
$165.83
|
| Rate for Payer: CDPHP Medicare |
$76.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$164.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$164.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$164.80
|
| Rate for Payer: EmblemHealth Medicaid |
$164.80
|
| Rate for Payer: EmblemHealth Medicare |
$70.04
|
| Rate for Payer: EmblemHealth Select Care |
$148.32
|
| Rate for Payer: Fidelis Medicare |
$78.51
|
| Rate for Payer: Galaxy Health Commercial |
$133.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$76.22
|
| Rate for Payer: Humana Medicare |
$76.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$94.76
|
| 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 |
$80.03
|
| 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 |
$76.22
|
| Rate for Payer: WellCare Medicare |
$113.30
|
|
|
PT RE-EVAL EST PLAN CARE (MOD 59)
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP,59
|
| Hospital Charge Code |
4650410
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
|
|
PT RE-EVAL EST PLAN CARE (MOD 59)
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP,59
|
| Hospital Charge Code |
4650410
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$85.34 |
| Max. Negotiated Rate |
$202.06 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$188.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$188.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: CDPHP Commercial |
$202.06
|
| Rate for Payer: CDPHP Medicare |
$92.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$200.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$200.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$200.80
|
| Rate for Payer: EmblemHealth Medicaid |
$200.80
|
| Rate for Payer: EmblemHealth Medicare |
$85.34
|
| Rate for Payer: EmblemHealth Select Care |
$180.72
|
| Rate for Payer: Fidelis Medicare |
$95.66
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.87
|
| Rate for Payer: Humana Medicare |
$92.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| 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 |
$97.51
|
| 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 |
$92.87
|
| Rate for Payer: WellCare Medicare |
$138.05
|
|
|
PT RE-EVAL EST PLAN CARE (MOD 59 W KX)
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP,59,KX
|
| Hospital Charge Code |
4650462
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
|
|
PT RE-EVAL EST PLAN CARE (MOD 59 W KX)
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP,59,KX
|
| Hospital Charge Code |
4650462
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$85.34 |
| Max. Negotiated Rate |
$202.06 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$188.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$188.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: CDPHP Commercial |
$202.06
|
| Rate for Payer: CDPHP Medicare |
$92.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$200.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$200.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$200.80
|
| Rate for Payer: EmblemHealth Medicaid |
$200.80
|
| Rate for Payer: EmblemHealth Medicare |
$85.34
|
| Rate for Payer: EmblemHealth Select Care |
$180.72
|
| Rate for Payer: Fidelis Medicare |
$95.66
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.87
|
| Rate for Payer: Humana Medicare |
$92.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| 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 |
$97.51
|
| 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 |
$92.87
|
| Rate for Payer: WellCare Medicare |
$138.05
|
|
|
PT RE-EVAL EST PLAN CARE (W/ KX)
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP,KX
|
| Hospital Charge Code |
4650358
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
|
|
PT RE-EVAL EST PLAN CARE (W/ KX)
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP,KX
|
| Hospital Charge Code |
4650358
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$85.34 |
| Max. Negotiated Rate |
$202.06 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$188.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$188.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$92.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: Cash Price |
$188.25
|
| Rate for Payer: CDPHP Commercial |
$202.06
|
| Rate for Payer: CDPHP Medicare |
$92.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$200.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$200.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$200.80
|
| Rate for Payer: EmblemHealth Medicaid |
$200.80
|
| Rate for Payer: EmblemHealth Medicare |
$85.34
|
| Rate for Payer: EmblemHealth Select Care |
$180.72
|
| Rate for Payer: Fidelis Medicare |
$95.66
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$92.87
|
| Rate for Payer: Humana Medicare |
$92.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| 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 |
$97.51
|
| 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 |
$92.87
|
| Rate for Payer: WellCare Medicare |
$138.05
|
|
|
PTT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
4300676
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.01
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
PTT
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
4300676
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
PULMONARY STRESS TEST
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
4530031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$722.89 |
| Rate for Payer: Aetna of NY Commercial |
$628.60
|
| Rate for Payer: Aetna of NY Medicare |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$332.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$449.00
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: CDPHP Commercial |
$722.89
|
| Rate for Payer: CDPHP Medicare |
$332.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$628.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$718.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$718.40
|
| Rate for Payer: EmblemHealth Medicaid |
$718.40
|
| Rate for Payer: EmblemHealth Medicare |
$305.32
|
| Rate for Payer: EmblemHealth Select Care |
$583.70
|
| Rate for Payer: Fidelis Medicare |
$342.23
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$332.26
|
| Rate for Payer: Humana Medicare |
$332.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$628.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$413.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$505.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$348.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.18
|
| Rate for Payer: United Healthcare Medicare |
$332.26
|
| Rate for Payer: WellCare Medicare |
$493.90
|
|
|
PULMONARY STRESS TEST
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
4530031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$583.70 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
4530014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$256.20
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$256.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$237.90
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$256.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.89
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
4530014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
PULSE OXIMETRY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4480088
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
|
|
PULSE OXIMETRY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4480088
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna of NY Commercial |
$46.90
|
| Rate for Payer: Aetna of NY Medicare |
$30.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$50.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.50
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: CDPHP Commercial |
$53.94
|
| Rate for Payer: CDPHP Medicare |
$24.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.60
|
| Rate for Payer: EmblemHealth Medicaid |
$53.60
|
| Rate for Payer: EmblemHealth Medicare |
$22.78
|
| Rate for Payer: EmblemHealth Select Care |
$43.55
|
| Rate for Payer: Fidelis Medicare |
$25.53
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.79
|
| Rate for Payer: Humana Medicare |
$24.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$46.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.66
|
| Rate for Payer: United Healthcare Medicare |
$24.79
|
| Rate for Payer: WellCare Medicare |
$36.85
|
|
|
PULSE OXIMETRY CONT
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
4530034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$148.83 |
| Max. Negotiated Rate |
$359.84 |
| Rate for Payer: Aetna of NY Commercial |
$312.90
|
| Rate for Payer: Aetna of NY Medicare |
$205.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$335.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$165.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$223.50
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: CDPHP Commercial |
$359.84
|
| Rate for Payer: CDPHP Medicare |
$165.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$312.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$357.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$357.60
|
| Rate for Payer: EmblemHealth Medicaid |
$357.60
|
| Rate for Payer: EmblemHealth Medicare |
$151.98
|
| Rate for Payer: EmblemHealth Select Care |
$290.55
|
| Rate for Payer: Fidelis Medicare |
$170.35
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$165.39
|
| Rate for Payer: Humana Medicare |
$165.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$312.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$205.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$335.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$251.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$173.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.83
|
| Rate for Payer: United Healthcare Medicare |
$165.39
|
| Rate for Payer: WellCare Medicare |
$245.85
|
|
|
PULSE OXIMETRY CONT
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
4530034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$290.55 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Galaxy Health Commercial |
$290.55
|
|
|
PULSE OX MULTIPLE RESPIRATORY
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
4530043
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna of NY Commercial |
$9.80
|
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.00
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Commercial |
$11.27
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$9.10
|
| Rate for Payer: Fidelis Medicare |
$5.34
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.99
|
| Rate for Payer: United Healthcare Medicare |
$5.18
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
