|
OT ELECTRICAL STIMULATION EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO,59,KX
|
| Hospital Charge Code |
4690243
|
|
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 W KX)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO,59,KX
|
| Hospital Charge Code |
4690243
|
|
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 (W/ KX)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO,KX
|
| Hospital Charge Code |
4690177
|
|
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 (W/ KX)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 97032 GO,KX
|
| Hospital Charge Code |
4690177
|
|
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 ELECTRIC CURRENT THERAPY EA 15 MINS
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO
|
| Hospital Charge Code |
4690010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
OT ELECTRIC CURRENT THERAPY EA 15 MINS
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO
|
| Hospital Charge Code |
4690010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
OT ELECTRIC CURRENT THERAPY EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO,59
|
| Hospital Charge Code |
4690213
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
OT ELECTRIC CURRENT THERAPY EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO,59
|
| Hospital Charge Code |
4690213
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
OT ELECTRIC CURRENT THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO,59,KX
|
| Hospital Charge Code |
4690244
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
OT ELECTRIC CURRENT THERAPY EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO,59,KX
|
| Hospital Charge Code |
4690244
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
OT ELECTRIC CURRENT THERAPY EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO,KX
|
| Hospital Charge Code |
4690178
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: CDPHP Commercial |
$57.16
|
| Rate for Payer: CDPHP Medicare |
$26.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.80
|
| Rate for Payer: EmblemHealth Medicaid |
$56.80
|
| Rate for Payer: EmblemHealth Medicare |
$24.14
|
| Rate for Payer: EmblemHealth Select Care |
$51.12
|
| Rate for Payer: Fidelis Medicare |
$27.06
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.27
|
| Rate for Payer: Humana Medicare |
$26.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.66
|
| 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 |
$27.58
|
| 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 |
$26.27
|
| Rate for Payer: WellCare Medicare |
$39.05
|
|
|
OT ELECTRIC CURRENT THERAPY EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 97033 GO,KX
|
| Hospital Charge Code |
4690178
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Galaxy Health Commercial |
$46.15
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO
|
| Hospital Charge Code |
4690004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| 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 |
$40.79
|
| 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 |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO
|
| Hospital Charge Code |
4690004
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO,59
|
| Hospital Charge Code |
4690207
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO,59
|
| Hospital Charge Code |
4690207
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| 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 |
$40.79
|
| 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 |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO,59,KX
|
| Hospital Charge Code |
4690238
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO,59,KX
|
| Hospital Charge Code |
4690238
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| 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 |
$40.79
|
| 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 |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO,KX
|
| Hospital Charge Code |
4690172
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| 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 |
$40.79
|
| 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 |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
OT ELECTRIC STIMULATION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 97014 GO,KX
|
| Hospital Charge Code |
4690172
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 97167 GO
|
| Hospital Charge Code |
4690002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$293.82 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$167.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$273.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$273.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: CDPHP Commercial |
$293.82
|
| Rate for Payer: CDPHP Medicare |
$135.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.00
|
| Rate for Payer: EmblemHealth Medicaid |
$292.00
|
| Rate for Payer: EmblemHealth Medicare |
$124.10
|
| Rate for Payer: EmblemHealth Select Care |
$262.80
|
| Rate for Payer: Fidelis Medicare |
$139.10
|
| Rate for Payer: Galaxy Health Commercial |
$237.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.05
|
| Rate for Payer: Humana Medicare |
$135.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$167.90
|
| 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 |
$141.80
|
| 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 |
$135.05
|
| Rate for Payer: WellCare Medicare |
$200.75
|
|
|
OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 97167 GO
|
| Hospital Charge Code |
4690002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$237.25 |
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Galaxy Health Commercial |
$237.25
|
|
|
OT EVAL HIGH COMPLEX 60 MIN (MOD 59)
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 97167 GO,59
|
| Hospital Charge Code |
4690205
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$293.82 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$167.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$273.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$273.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: CDPHP Commercial |
$293.82
|
| Rate for Payer: CDPHP Medicare |
$135.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.00
|
| Rate for Payer: EmblemHealth Medicaid |
$292.00
|
| Rate for Payer: EmblemHealth Medicare |
$124.10
|
| Rate for Payer: EmblemHealth Select Care |
$262.80
|
| Rate for Payer: Fidelis Medicare |
$139.10
|
| Rate for Payer: Galaxy Health Commercial |
$237.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.05
|
| Rate for Payer: Humana Medicare |
$135.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$167.90
|
| 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 |
$141.80
|
| 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 |
$135.05
|
| Rate for Payer: WellCare Medicare |
$200.75
|
|
|
OT EVAL HIGH COMPLEX 60 MIN (MOD 59)
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 97167 GO,59
|
| Hospital Charge Code |
4690205
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$237.25 |
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Galaxy Health Commercial |
$237.25
|
|
|
OT EVAL HIGH COMPLEX 60 MIN (MOD 59 W KX)
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 97167 GO,59,KX
|
| Hospital Charge Code |
4690236
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$293.82 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$167.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$273.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$273.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: CDPHP Commercial |
$293.82
|
| Rate for Payer: CDPHP Medicare |
$135.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$292.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.00
|
| Rate for Payer: EmblemHealth Medicaid |
$292.00
|
| Rate for Payer: EmblemHealth Medicare |
$124.10
|
| Rate for Payer: EmblemHealth Select Care |
$262.80
|
| Rate for Payer: Fidelis Medicare |
$139.10
|
| Rate for Payer: Galaxy Health Commercial |
$237.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.05
|
| Rate for Payer: Humana Medicare |
$135.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$167.90
|
| 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 |
$141.80
|
| 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 |
$135.05
|
| Rate for Payer: WellCare Medicare |
$200.75
|
|
