|
THERASKIN PER 1 SQ CM (102TSL)
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
4473007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of NY Commercial |
$75.60
|
| 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: Cash Price |
$81.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$54.00
|
| Rate for Payer: EmblemHealth Select Care |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$48.60
|
| 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: WellCare Medicare |
$59.40
|
|
|
THERA TABLET 1 ea, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904053961
|
| Hospital Charge Code |
4401350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
THERA TABLET 1 ea, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904053961
|
| Hospital Charge Code |
4401350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
THER/DIAG CONCURRENT INF
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
4451243
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$400.55 |
| Rate for Payer: Aetna of NY Commercial |
$102.90
|
| Rate for Payer: Aetna of NY Medicare |
$67.62
|
| 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) Medicare |
$54.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$73.50
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: CDPHP Commercial |
$118.34
|
| Rate for Payer: CDPHP Medicare |
$54.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$117.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$117.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.60
|
| Rate for Payer: EmblemHealth Medicaid |
$117.60
|
| Rate for Payer: EmblemHealth Medicare |
$49.98
|
| Rate for Payer: EmblemHealth Select Care |
$105.84
|
| Rate for Payer: Fidelis Medicare |
$56.02
|
| Rate for Payer: Galaxy Health Commercial |
$95.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.39
|
| Rate for Payer: Humana Medicare |
$54.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$102.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$110.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$110.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.05
|
| Rate for Payer: United Healthcare Commercial |
$110.25
|
| Rate for Payer: United Healthcare Medicare |
$54.39
|
| Rate for Payer: WellCare Medicare |
$80.85
|
|
|
THER/DIAG CONCURRENT INF
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
4451243
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$95.55 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Galaxy Health Commercial |
$95.55
|
|
|
THER INT COG FUNC 1ST 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
4670281
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$29.58 |
| Max. Negotiated Rate |
$4,708.00 |
| 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) Essential Plan |
$105.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$47.08
|
| 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 Child Health Plus/HARP/Select Plan |
$47.08
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Essential Plan |
$105.93
|
| 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 |
$56.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.08
|
| Rate for Payer: EmblemHealth Medicaid |
$47.08
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$62.64
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$105.93
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Galaxy Health Workers Comp |
$69.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,708.00
|
| 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 Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,708.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$101.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$101.22
|
| 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 CHIP/Family Health Plus/Medicaid |
$47.08
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$32.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$49.43
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
THER INT COG FUNC 1ST 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
4670281
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GO
|
| Hospital Charge Code |
4690199
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GN
|
| Hospital Charge Code |
4670277
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GN
|
| Hospital Charge Code |
4670277
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GO
|
| Hospital Charge Code |
4690199
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN (W/ KX)
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GN,KX
|
| Hospital Charge Code |
4670279
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN (W/ KX)
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GO,KX
|
| Hospital Charge Code |
4690201
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN (W/ KX)
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GO,KX
|
| Hospital Charge Code |
4690201
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
THER INT COG FUNC 1ST 15 MIN (W/ KX)
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 97129 GN,KX
|
| Hospital Charge Code |
4670279
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
THER INT COG FUNC EA ADD 15 MIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GO
|
| Hospital Charge Code |
4690200
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: CDPHP Commercial |
$66.82
|
| Rate for Payer: CDPHP Medicare |
$30.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$66.40
|
| Rate for Payer: EmblemHealth Medicaid |
$66.40
|
| Rate for Payer: EmblemHealth Medicare |
$28.22
|
| Rate for Payer: EmblemHealth Select Care |
$59.76
|
| Rate for Payer: Fidelis Medicare |
$31.63
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.71
|
| Rate for Payer: Humana Medicare |
$30.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$38.18
|
| 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 |
$32.25
|
| 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 |
$30.71
|
| Rate for Payer: WellCare Medicare |
$45.65
|
|
|
THER INT COG FUNC EA ADD 15 MIN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GO
|
| Hospital Charge Code |
4690200
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
|
|
THER INT COG FUNC EA ADD 15 MIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GN
|
| Hospital Charge Code |
4670278
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: CDPHP Commercial |
$66.82
|
| Rate for Payer: CDPHP Medicare |
$30.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$66.40
|
| Rate for Payer: EmblemHealth Medicaid |
$66.40
|
| Rate for Payer: EmblemHealth Medicare |
$28.22
|
| Rate for Payer: EmblemHealth Select Care |
$59.76
|
| Rate for Payer: Fidelis Medicare |
$31.63
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.71
|
| Rate for Payer: Humana Medicare |
$30.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$38.18
|
| 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 |
$32.25
|
| 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 |
$30.71
|
| Rate for Payer: WellCare Medicare |
$45.65
|
|
|
THER INT COG FUNC EA ADD 15 MIN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
4670282
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
|
|
THER INT COG FUNC EA ADD 15 MIN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GN
|
| Hospital Charge Code |
4670278
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
|
|
THER INT COG FUNC EA ADD 15 MIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
4670282
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$4,708.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$105.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$47.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$47.08
|
| Rate for Payer: CDPHP Commercial |
$66.82
|
| Rate for Payer: CDPHP Essential Plan |
$105.93
|
| Rate for Payer: CDPHP Medicare |
$30.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.08
|
| Rate for Payer: EmblemHealth Medicaid |
$47.08
|
| Rate for Payer: EmblemHealth Medicare |
$28.22
|
| Rate for Payer: EmblemHealth Select Care |
$59.76
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$105.93
|
| Rate for Payer: Fidelis Medicare |
$31.63
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
| Rate for Payer: Galaxy Health Workers Comp |
$69.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,708.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.71
|
| Rate for Payer: Humana Medicare |
$30.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$38.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,708.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$101.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$101.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.08
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$30.71
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$49.43
|
| Rate for Payer: WellCare Medicare |
$45.65
|
|
|
THER INT COG FUNC EA ADD 15 MIN (W/ KX)
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GO,KX
|
| Hospital Charge Code |
4690202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: CDPHP Commercial |
$66.82
|
| Rate for Payer: CDPHP Medicare |
$30.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$66.40
|
| Rate for Payer: EmblemHealth Medicaid |
$66.40
|
| Rate for Payer: EmblemHealth Medicare |
$28.22
|
| Rate for Payer: EmblemHealth Select Care |
$59.76
|
| Rate for Payer: Fidelis Medicare |
$31.63
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.71
|
| Rate for Payer: Humana Medicare |
$30.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$38.18
|
| 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 |
$32.25
|
| 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 |
$30.71
|
| Rate for Payer: WellCare Medicare |
$45.65
|
|
|
THER INT COG FUNC EA ADD 15 MIN (W/ KX)
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GN,KX
|
| Hospital Charge Code |
4670280
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
|
|
THER INT COG FUNC EA ADD 15 MIN (W/ KX)
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GN,KX
|
| Hospital Charge Code |
4670280
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$38.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$62.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: CDPHP Commercial |
$66.82
|
| Rate for Payer: CDPHP Medicare |
$30.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$66.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$66.40
|
| Rate for Payer: EmblemHealth Medicaid |
$66.40
|
| Rate for Payer: EmblemHealth Medicare |
$28.22
|
| Rate for Payer: EmblemHealth Select Care |
$59.76
|
| Rate for Payer: Fidelis Medicare |
$31.63
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.71
|
| Rate for Payer: Humana Medicare |
$30.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$38.18
|
| 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 |
$32.25
|
| 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 |
$30.71
|
| Rate for Payer: WellCare Medicare |
$45.65
|
|
|
THER INT COG FUNC EA ADD 15 MIN (W/ KX)
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 97130 GO,KX
|
| Hospital Charge Code |
4690202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Galaxy Health Commercial |
$53.95
|
|
