|
OT PHYSICAL PERFORM EA 15M (MOD 59)
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GO,59
|
| Hospital Charge Code |
4690228
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
OT PHYSICAL PERFORM EA 15M (MOD 59)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GO,59
|
| Hospital Charge Code |
4690228
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$87.84
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| 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 |
$47.40
|
| 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 |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
OT PHYSICAL PERFORM EA 15M (MOD 59 W KX)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GO,59,KX
|
| Hospital Charge Code |
4690259
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$87.84
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| 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 |
$47.40
|
| 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 |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
OT PHYSICAL PERFORM EA 15M (MOD 59 W KX)
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GO,59,KX
|
| Hospital Charge Code |
4690259
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
OT PHYSICAL PERFORM EA 15M (W/ KX)
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GO,KX
|
| Hospital Charge Code |
4690193
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$87.84
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| 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 |
$47.40
|
| 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 |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
OT PHYSICAL PERFORM EA 15M (W/ KX)
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 97750 GO,KX
|
| Hospital Charge Code |
4690193
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
OT RE-EVAL EST PLAN CARE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO
|
| Hospital Charge Code |
4690003
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$202.86 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$93.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: CDPHP Commercial |
$202.86
|
| Rate for Payer: CDPHP Medicare |
$93.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$201.60
|
| Rate for Payer: EmblemHealth Medicaid |
$201.60
|
| Rate for Payer: EmblemHealth Medicare |
$85.68
|
| Rate for Payer: EmblemHealth Select Care |
$181.44
|
| Rate for Payer: Fidelis Medicare |
$96.04
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$93.24
|
| Rate for Payer: Humana Medicare |
$93.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.92
|
| 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 |
$97.90
|
| 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 |
$93.24
|
| Rate for Payer: WellCare Medicare |
$138.60
|
|
|
OT RE-EVAL EST PLAN CARE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO
|
| Hospital Charge Code |
4690003
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
|
|
OT RE-EVAL EST PLAN CARE (MOD 59)
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO,59
|
| Hospital Charge Code |
4690206
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
|
|
OT RE-EVAL EST PLAN CARE (MOD 59)
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO,59
|
| Hospital Charge Code |
4690206
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$202.86 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$93.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: CDPHP Commercial |
$202.86
|
| Rate for Payer: CDPHP Medicare |
$93.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$201.60
|
| Rate for Payer: EmblemHealth Medicaid |
$201.60
|
| Rate for Payer: EmblemHealth Medicare |
$85.68
|
| Rate for Payer: EmblemHealth Select Care |
$181.44
|
| Rate for Payer: Fidelis Medicare |
$96.04
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$93.24
|
| Rate for Payer: Humana Medicare |
$93.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.92
|
| 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 |
$97.90
|
| 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 |
$93.24
|
| Rate for Payer: WellCare Medicare |
$138.60
|
|
|
OT RE-EVAL EST PLAN CARE (MOD 59 W KX)
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO,59,KX
|
| Hospital Charge Code |
4690237
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$202.86 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$93.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: CDPHP Commercial |
$202.86
|
| Rate for Payer: CDPHP Medicare |
$93.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$201.60
|
| Rate for Payer: EmblemHealth Medicaid |
$201.60
|
| Rate for Payer: EmblemHealth Medicare |
$85.68
|
| Rate for Payer: EmblemHealth Select Care |
$181.44
|
| Rate for Payer: Fidelis Medicare |
$96.04
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$93.24
|
| Rate for Payer: Humana Medicare |
$93.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.92
|
| 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 |
$97.90
|
| 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 |
$93.24
|
| Rate for Payer: WellCare Medicare |
$138.60
|
|
|
OT RE-EVAL EST PLAN CARE (MOD 59 W KX)
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO,59,KX
|
| Hospital Charge Code |
4690237
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
|
|
OT RE-EVAL EST PLAN CARE (W/ KX)
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO,KX
|
| Hospital Charge Code |
4690171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$202.86 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$115.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$93.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: CDPHP Commercial |
$202.86
|
| Rate for Payer: CDPHP Medicare |
$93.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$201.60
|
| Rate for Payer: EmblemHealth Medicaid |
$201.60
|
| Rate for Payer: EmblemHealth Medicare |
$85.68
|
| Rate for Payer: EmblemHealth Select Care |
$181.44
|
| Rate for Payer: Fidelis Medicare |
$96.04
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$93.24
|
| Rate for Payer: Humana Medicare |
$93.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.92
|
| 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 |
$97.90
|
| 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 |
$93.24
|
| Rate for Payer: WellCare Medicare |
$138.60
|
|
|
OT RE-EVAL EST PLAN CARE (W/ KX)
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 97168 GO,KX
|
| Hospital Charge Code |
4690171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
4690020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
4690020
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| 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 |
$46.23
|
| 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 |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59
|
| Hospital Charge Code |
4690222
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| 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 |
$46.23
|
| 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 |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59
|
| Hospital Charge Code |
4690222
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59,KX
|
| Hospital Charge Code |
4690253
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| 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 |
$46.23
|
| 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 |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59,KX
|
| Hospital Charge Code |
4690253
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,KX
|
| Hospital Charge Code |
4690187
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$89.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$44.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: CDPHP Commercial |
$95.80
|
| Rate for Payer: CDPHP Medicare |
$44.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$95.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$95.20
|
| Rate for Payer: EmblemHealth Medicaid |
$95.20
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$45.35
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$44.03
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| 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 |
$46.23
|
| 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 |
$44.03
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT SELF CARE MNGMENT TRAINING EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,KX
|
| Hospital Charge Code |
4690187
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Cash Price |
$89.25
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
|
|
OT SENSORY INTEGRATION EA 15 MINS
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 97533 GO
|
| Hospital Charge Code |
4690019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Galaxy Health Commercial |
$156.00
|
|
|
OT SENSORY INTEGRATION EA 15 MINS
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 97533 GO
|
| Hospital Charge Code |
4690019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$88.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: CDPHP Commercial |
$193.20
|
| Rate for Payer: CDPHP Medicare |
$88.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$192.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$192.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$192.00
|
| Rate for Payer: EmblemHealth Medicaid |
$192.00
|
| Rate for Payer: EmblemHealth Medicare |
$81.60
|
| Rate for Payer: EmblemHealth Select Care |
$172.80
|
| Rate for Payer: Fidelis Medicare |
$91.46
|
| Rate for Payer: Galaxy Health Commercial |
$156.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$88.80
|
| Rate for Payer: Humana Medicare |
$88.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$110.40
|
| 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 |
$93.24
|
| 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 |
$88.80
|
| Rate for Payer: WellCare Medicare |
$132.00
|
|
|
OT SENSORY INTEGRATION EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 97533 GO,59
|
| Hospital Charge Code |
4690221
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$110.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$88.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: CDPHP Commercial |
$193.20
|
| Rate for Payer: CDPHP Medicare |
$88.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$192.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$192.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$192.00
|
| Rate for Payer: EmblemHealth Medicaid |
$192.00
|
| Rate for Payer: EmblemHealth Medicare |
$81.60
|
| Rate for Payer: EmblemHealth Select Care |
$172.80
|
| Rate for Payer: Fidelis Medicare |
$91.46
|
| Rate for Payer: Galaxy Health Commercial |
$156.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$88.80
|
| Rate for Payer: Humana Medicare |
$88.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$110.40
|
| 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 |
$93.24
|
| 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 |
$88.80
|
| Rate for Payer: WellCare Medicare |
$132.00
|
|
