|
THERAPEUTIC ACTIVITY 15 MIN
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN
|
| Hospital Charge Code |
4670074
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
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)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GN,59
|
| Hospital Charge Code |
4670290
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
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 |
$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
|
|
|
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 |
$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
|
|
|
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 |
$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
|
|
|
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)
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 97530 GP,59
|
| Hospital Charge Code |
4650376
|
|
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
|
|
|
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 |
$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
|
|
|
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 |
$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
|
|
|
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
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP
|
| Hospital Charge Code |
4650039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
THERAPEUTIC EXERCISES 15 MIN
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP
|
| Hospital Charge Code |
4650039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| 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 |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$37.60
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.60
|
| Rate for Payer: Humana Medicare |
$37.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$39.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$37.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59)
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP,59
|
| Hospital Charge Code |
4650377
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| 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 |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$37.60
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.60
|
| Rate for Payer: Humana Medicare |
$37.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$39.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$37.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59)
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP,59
|
| Hospital Charge Code |
4650377
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP,59,KX
|
| Hospital Charge Code |
4650429
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| 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 |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$37.60
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.60
|
| Rate for Payer: Humana Medicare |
$37.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$39.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$37.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
THERAPEUTIC EXERCISES 15 MIN (MOD 59 W KX)
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP,59,KX
|
| Hospital Charge Code |
4650429
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
THERAPEUTIC EXERCISES 15 MIN (W/ KX)
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP,KX
|
| Hospital Charge Code |
4650322
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
|
|
THERAPEUTIC EXERCISES 15 MIN (W/ KX)
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 97110 GP,KX
|
| Hospital Charge Code |
4650322
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$43.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$37.60
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: CDPHP Medicare |
$34.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$75.20
|
| 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 |
$31.96
|
| Rate for Payer: EmblemHealth Select Care |
$67.68
|
| Rate for Payer: Fidelis Medicare |
$37.60
|
| Rate for Payer: Galaxy Health Commercial |
$61.10
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$37.60
|
| Rate for Payer: Humana Medicare |
$37.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.24
|
| 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 |
$39.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$37.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$51.70
|
|
|
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
4856726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Galaxy Health Commercial |
$143.65
|
|
|
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
4856726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna of NY Commercial |
$154.70
|
| Rate for Payer: Aetna of NY Medicare |
$101.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$88.40
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: CDPHP Medicare |
$81.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$176.80
|
| 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 |
$75.14
|
| Rate for Payer: EmblemHealth Select Care |
$159.12
|
| Rate for Payer: Fidelis Medicare |
$88.40
|
| Rate for Payer: Galaxy Health Commercial |
$143.65
|
| Rate for Payer: Galaxy Health Workers Comp |
$13.09
|
| Rate for Payer: Hamaspik Choice Medicaid |
$13.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$88.40
|
| Rate for Payer: Humana Medicare |
$88.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$154.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$101.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$14.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$165.75
|
| 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 |
$124.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$92.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.15
|
| Rate for Payer: United Healthcare Medicare |
$88.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$14.03
|
| Rate for Payer: WellCare Medicare |
$121.55
|
|
