|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (MOD 59)
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS G0129 GO,59
|
| Hospital Charge Code |
4650383
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (MOD 59 W KX)
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS G0129 GO,59,KX
|
| Hospital Charge Code |
4650435
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Commercial |
$156.98
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$140.40
|
| Rate for Payer: Fidelis Medicare |
$74.31
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.15
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| 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 |
$75.76
|
| 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 |
$72.15
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (MOD 59 W KX)
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS G0129 GO,59,KX
|
| Hospital Charge Code |
4650435
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (W/ KX)
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS G0129 GO,KX
|
| Hospital Charge Code |
4650328
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$89.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$146.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: CDPHP Commercial |
$156.98
|
| Rate for Payer: CDPHP Medicare |
$72.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.00
|
| Rate for Payer: EmblemHealth Medicaid |
$156.00
|
| Rate for Payer: EmblemHealth Medicare |
$66.30
|
| Rate for Payer: EmblemHealth Select Care |
$140.40
|
| Rate for Payer: Fidelis Medicare |
$74.31
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.15
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$89.70
|
| 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 |
$75.76
|
| 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 |
$72.15
|
| Rate for Payer: WellCare Medicare |
$107.25
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (W/ KX)
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS G0129 GO,KX
|
| Hospital Charge Code |
4650328
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Galaxy Health Commercial |
$126.75
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO
|
| Hospital Charge Code |
4690021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO
|
| Hospital Charge Code |
4690021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO,59
|
| Hospital Charge Code |
4690223
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO,59
|
| Hospital Charge Code |
4690223
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO,59,KX
|
| Hospital Charge Code |
4690254
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO,59,KX
|
| Hospital Charge Code |
4690254
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO,KX
|
| Hospital Charge Code |
4690188
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
OT COMMUNITY/WORK REINTEGRATION EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 97537 GO,KX
|
| Hospital Charge Code |
4690188
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$82.80
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| 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 |
$44.68
|
| 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 |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO
|
| Hospital Charge Code |
4690157
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO
|
| Hospital Charge Code |
4690157
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO,59
|
| Hospital Charge Code |
4690231
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO,59
|
| Hospital Charge Code |
4690231
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO,59,KX
|
| Hospital Charge Code |
4690262
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO,59,KX
|
| Hospital Charge Code |
4690262
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO,KX
|
| Hospital Charge Code |
4690196
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| 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 |
$22.14
|
| 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 |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
OT CONTRAST BATH THERAPY EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 97034 GO,KX
|
| Hospital Charge Code |
4690196
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
OT ELECTRICAL STIMULATION EA 15 MINS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO
|
| Hospital Charge Code |
4690009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
OT ELECTRICAL STIMULATION EA 15 MINS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO
|
| Hospital Charge Code |
4690009
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| 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 |
$20.20
|
| 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 |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
OT ELECTRICAL STIMULATION EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO,59
|
| Hospital Charge Code |
4690212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
OT ELECTRICAL STIMULATION EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO,59
|
| Hospital Charge Code |
4690212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$37.44
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| 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 |
$20.20
|
| 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 |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
