|
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 |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
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 |
$7.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| 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 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 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
4650302
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$248.30 |
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Galaxy Health Commercial |
$248.30
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 97163 GP
|
| Hospital Charge Code |
4650302
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$175.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$152.80
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: CDPHP Medicare |
$141.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$305.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$129.88
|
| Rate for Payer: EmblemHealth Select Care |
$275.04
|
| Rate for Payer: Fidelis Medicare |
$152.80
|
| Rate for Payer: Galaxy Health Commercial |
$248.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$152.80
|
| Rate for Payer: Humana Medicare |
$152.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$175.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$160.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$57.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$152.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$210.10
|
|
|
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 |
$54.30 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| 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
|
|
|
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 |
$54.30 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| 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
|
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 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 |
$54.30 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
4650300
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$289.60 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$105.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$88.20
|
| Rate for Payer: EmblemHealth Medicaid |
$88.20
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$92.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 97161 GP
|
| Hospital Charge Code |
4650300
|
|
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
|
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 |
$54.30 |
| Max. Negotiated Rate |
$289.60 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$105.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$88.20
|
| Rate for Payer: EmblemHealth Medicaid |
$88.20
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$92.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| 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 |
$54.30 |
| Max. Negotiated Rate |
$289.60 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$105.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$88.20
|
| Rate for Payer: EmblemHealth Medicaid |
$88.20
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$92.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| 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 |
$54.30 |
| Max. Negotiated Rate |
$289.60 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$105.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$88.20
|
| Rate for Payer: EmblemHealth Medicaid |
$88.20
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$92.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$189.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| 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
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
4650301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$241.80 |
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Galaxy Health Commercial |
$241.80
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 97162 GP
|
| Hospital Charge Code |
4650301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$171.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$148.80
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: CDPHP Medicare |
$137.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$297.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$141.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.60
|
| Rate for Payer: EmblemHealth Medicaid |
$117.60
|
| Rate for Payer: EmblemHealth Medicare |
$126.48
|
| Rate for Payer: EmblemHealth Select Care |
$267.84
|
| Rate for Payer: Fidelis Medicare |
$148.80
|
| Rate for Payer: Galaxy Health Commercial |
$241.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$115.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$148.80
|
| Rate for Payer: Humana Medicare |
$148.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$171.12
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$123.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$156.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$55.80
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$148.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.48
|
| Rate for Payer: WellCare Medicare |
$204.60
|
|
|
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 |
$54.30 |
| Max. Negotiated Rate |
$289.60 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$141.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.60
|
| Rate for Payer: EmblemHealth Medicaid |
$117.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$115.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$123.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.48
|
| 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
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 97162 GP,59,KX
|
| Hospital Charge Code |
4650460
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$289.60 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$166.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$144.80
|
| 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 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 |
$141.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.60
|
| Rate for Payer: EmblemHealth Medicaid |
$117.60
|
| Rate for Payer: EmblemHealth Medicare |
$123.08
|
| Rate for Payer: EmblemHealth Select Care |
$260.64
|
| Rate for Payer: Fidelis Medicare |
$144.80
|
| Rate for Payer: Galaxy Health Commercial |
$235.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$115.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$144.80
|
| Rate for Payer: Humana Medicare |
$144.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$166.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$123.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.30
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.48
|
| Rate for Payer: WellCare Medicare |
$199.10
|
|
|
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
|
|
