|
THERAPEUTIC ACTIVITY 15 MIN (MOD 59)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN,59
|
| Hospital Charge Code |
4670290
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THERAPEUTIC ACTIVITY 15 MIN (MOD 59)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN,59
|
| Hospital Charge Code |
4670290
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THERAPEUTIC ACTIVITY 15 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN,59,KX
|
| Hospital Charge Code |
4670306
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THERAPEUTIC ACTIVITY 15 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN,59,KX
|
| Hospital Charge Code |
4670306
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THERAPEUTIC ACTIVITY 15 MIN (W/ KX)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN,KX
|
| Hospital Charge Code |
4670268
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THERAPEUTIC ACTIVITY 15 MIN (W/ KX)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN,KX
|
| Hospital Charge Code |
4670268
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4650038
|
|
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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
4650038
|
|
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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN (MOD 59)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP,59
|
| Hospital Charge Code |
4650376
|
|
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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN (MOD 59)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP,59
|
| Hospital Charge Code |
4650376
|
|
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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP,59,KX
|
| Hospital Charge Code |
4650428
|
|
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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP,59,KX
|
| Hospital Charge Code |
4650428
|
|
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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN (W/ KX)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP,KX
|
| Hospital Charge Code |
4650321
|
|
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
|
|
|
THERAPEUTIC DIRECT ACTIVITY 15 MIN (W/ KX)
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP,KX
|
| Hospital Charge Code |
4650321
|
|
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
|
|
|
THERAPEUTIC EXERCISES 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP
|
| Hospital Charge Code |
4650039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
THERAPEUTIC EXERCISES 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP
|
| Hospital Charge Code |
4650039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$62.64
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| 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 |
$33.80
|
| 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 |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59)
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP,59
|
| Hospital Charge Code |
4650377
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59)
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP,59
|
| Hospital Charge Code |
4650377
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$62.64
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| 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 |
$33.80
|
| 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 |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP,59,KX
|
| Hospital Charge Code |
4650429
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP,59,KX
|
| Hospital Charge Code |
4650429
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$62.64
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| 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 |
$33.80
|
| 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 |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
THERAPEUTIC EXERCISES 15 MIN (W/ KX)
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP,KX
|
| Hospital Charge Code |
4650322
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$62.64
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| 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 |
$33.80
|
| 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 |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
THERAPEUTIC EXERCISES 15 MIN (W/ KX)
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97110 GP,KX
|
| Hospital Charge Code |
4650322
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
4856726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna of NY Commercial |
$141.40
|
| Rate for Payer: Aetna of NY Medicare |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$13.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.74
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$101.00
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$13.36
|
| Rate for Payer: CDPHP Commercial |
$162.61
|
| Rate for Payer: CDPHP Essential Plan |
$30.06
|
| Rate for Payer: CDPHP Medicare |
$74.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.36
|
| Rate for Payer: EmblemHealth Medicaid |
$13.36
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: EmblemHealth Select Care |
$145.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$30.06
|
| Rate for Payer: Fidelis Medicare |
$76.98
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Galaxy Health Workers Comp |
$19.64
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,336.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.74
|
| Rate for Payer: Humana Medicare |
$74.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$28.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$28.72
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare |
$74.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$14.03
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
|
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
4856726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
|
|
THERASKIN PER 1 SQ CM (102TSL)
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
4473007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna of NY Commercial |
$75.60
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$54.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Commercial |
$86.94
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$54.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.40
|
| Rate for Payer: EmblemHealth Medicaid |
$86.40
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: EmblemHealth Select Care |
$54.00
|
| Rate for Payer: Fidelis Medicare |
$41.16
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.96
|
| Rate for Payer: Humana Medicare |
$39.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$70.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$70.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$46.13
|
| Rate for Payer: United Healthcare Medicare |
$39.96
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
