|
PT MANUAL THERAPY EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97140 GP,KX
|
| Hospital Charge Code |
4650304
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
PT NON WND ELECT STIM
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
4650127
|
|
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
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
4650127
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| 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 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 |
$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 |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| 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 |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
PT NON WND ELECT STIM (MOD 59)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP,59
|
| Hospital Charge Code |
4650406
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| 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 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 |
$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 |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| 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 |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
PT NON WND ELECT STIM (MOD 59)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP,59
|
| Hospital Charge Code |
4650406
|
|
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 (MOD 59 W KX)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP,59,KX
|
| Hospital Charge Code |
4650458
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| 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 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 |
$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 |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| 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 |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
PT NON WND ELECT STIM (MOD 59 W KX)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GP,59,KX
|
| Hospital Charge Code |
4650458
|
|
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 |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| 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 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 |
$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 |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| 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 |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
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
|
|
|
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 HALF HOUR
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4650058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.40
|
| 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 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 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$54.40
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.40
|
| Rate for Payer: Humana Medicare |
$54.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
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 |
$20.40 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.40
|
| 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 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 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Medicare |
$54.40
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.40
|
| Rate for Payer: Humana Medicare |
$54.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
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
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP
|
| Hospital Charge Code |
4650303
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$200.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.40
|
| 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 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 |
$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 |
$85.34
|
| Rate for Payer: EmblemHealth Select Care |
$180.72
|
| Rate for Payer: Fidelis Medicare |
$100.40
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.40
|
| Rate for Payer: Humana Medicare |
$100.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| 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 |
$105.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$100.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| Rate for Payer: WellCare Medicare |
$138.05
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 97164 GP
|
| Hospital Charge Code |
4650303
|
|
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
|
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 |
$37.65 |
| Max. Negotiated Rate |
$200.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.40
|
| 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 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 |
$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 |
$85.34
|
| Rate for Payer: EmblemHealth Select Care |
$180.72
|
| Rate for Payer: Fidelis Medicare |
$100.40
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.40
|
| Rate for Payer: Humana Medicare |
$100.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| 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 |
$105.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$100.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| 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 |
$37.65 |
| Max. Negotiated Rate |
$200.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.40
|
| 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 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 |
$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 |
$85.34
|
| Rate for Payer: EmblemHealth Select Care |
$180.72
|
| Rate for Payer: Fidelis Medicare |
$100.40
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.40
|
| Rate for Payer: Humana Medicare |
$100.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| 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 |
$105.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$100.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| Rate for Payer: WellCare Medicare |
$138.05
|
|
|
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 |
$37.65 |
| Max. Negotiated Rate |
$200.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.40
|
| 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 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 |
$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 |
$85.34
|
| Rate for Payer: EmblemHealth Select Care |
$180.72
|
| Rate for Payer: Fidelis Medicare |
$100.40
|
| Rate for Payer: Galaxy Health Commercial |
$163.15
|
| Rate for Payer: Galaxy Health Workers Comp |
$86.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$88.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.40
|
| Rate for Payer: Humana Medicare |
$100.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.46
|
| 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 |
$105.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$100.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$92.61
|
| 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
|
|
|
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
|
|
|
PTT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
4300676
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| 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) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| 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 |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| 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 |
$14.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
PULMONARY STRESS TEST
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
4530031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$915.20 |
| Rate for Payer: Aetna of NY Commercial |
$800.80
|
| Rate for Payer: Aetna of NY Medicare |
$526.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$457.60
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: CDPHP Medicare |
$423.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$800.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$915.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$915.20
|
| Rate for Payer: EmblemHealth Medicaid |
$915.20
|
| Rate for Payer: EmblemHealth Medicare |
$388.96
|
| Rate for Payer: EmblemHealth Select Care |
$743.60
|
| Rate for Payer: Fidelis Medicare |
$457.60
|
| Rate for Payer: Galaxy Health Commercial |
$743.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$457.60
|
| Rate for Payer: Humana Medicare |
$457.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$800.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$526.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$858.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$644.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$480.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$171.60
|
| Rate for Payer: United Healthcare Medicare |
$457.60
|
| Rate for Payer: WellCare Medicare |
$629.20
|
|
|
PULMONARY STRESS TEST
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
4530031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$743.60 |
| Max. Negotiated Rate |
$743.60 |
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Galaxy Health Commercial |
$743.60
|
|
