|
OT ADL/SELF CARE TR EA 15 M (MOD 59)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59
|
| Hospital Charge Code |
4650398
|
|
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 ADL/SELF CARE TR EA 15 M (MOD 59 W KX)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59,KX
|
| Hospital Charge Code |
4650450
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.60
|
| 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 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 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$47.60
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.60
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$47.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT ADL/SELF CARE TR EA 15 M (MOD 59 W KX)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,59,KX
|
| Hospital Charge Code |
4650450
|
|
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 ADL/SELF CARE TR EA 15 M (W/ KX)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,KX
|
| Hospital Charge Code |
4650346
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$54.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.60
|
| 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 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 |
$47.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.23
|
| Rate for Payer: EmblemHealth Medicaid |
$39.23
|
| Rate for Payer: EmblemHealth Medicare |
$40.46
|
| Rate for Payer: EmblemHealth Select Care |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$47.60
|
| Rate for Payer: Galaxy Health Commercial |
$77.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$38.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$39.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.60
|
| Rate for Payer: Humana Medicare |
$47.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$84.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$47.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$41.19
|
| Rate for Payer: WellCare Medicare |
$65.45
|
|
|
OT ADL/SELF CARE TR EA 15 M (W/ KX)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97535 GO,KX
|
| Hospital Charge Code |
4650346
|
|
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 APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105 GO
|
| Hospital Charge Code |
4690029
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
OT APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105 GO
|
| Hospital Charge Code |
4690029
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
OT APPLY SHORT ARM SPLINT; DYNAMIC
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126 GO
|
| Hospital Charge Code |
4690030
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
OT APPLY SHORT ARM SPLINT; DYNAMIC
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 29126 GO
|
| Hospital Charge Code |
4690030
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO
|
| Hospital Charge Code |
4650052
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO
|
| Hospital Charge Code |
4650052
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.00
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,59
|
| Hospital Charge Code |
4650385
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,59
|
| Hospital Charge Code |
4650385
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.00
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,59,KX
|
| Hospital Charge Code |
4650437
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.00
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,59,KX
|
| Hospital Charge Code |
4650437
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,KX
|
| Hospital Charge Code |
4650330
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
|
|
OT AQUATIC THERAPY/EXERCISES EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97113 GO,KX
|
| Hospital Charge Code |
4650330
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.00
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI
|
Facility
|
IP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO
|
| Hospital Charge Code |
4650049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$130.55 |
| Max. Negotiated Rate |
$130.55 |
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI
|
Facility
|
OP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO
|
| Hospital Charge Code |
4650049
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.34
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: CDPHP Medicare |
$74.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.68
|
| Rate for Payer: EmblemHealth Medicaid |
$160.68
|
| Rate for Payer: EmblemHealth Medicare |
$68.29
|
| Rate for Payer: EmblemHealth Select Care |
$144.61
|
| Rate for Payer: Fidelis Medicare |
$80.34
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.34
|
| Rate for Payer: Humana Medicare |
$80.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.13
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$80.34
|
| Rate for Payer: WellCare Medicare |
$110.47
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (MOD 59)
|
Facility
|
IP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO,59
|
| Hospital Charge Code |
4650383
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$130.55 |
| Max. Negotiated Rate |
$130.55 |
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (MOD 59)
|
Facility
|
OP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO,59
|
| Hospital Charge Code |
4650383
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.34
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: CDPHP Medicare |
$74.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.68
|
| Rate for Payer: EmblemHealth Medicaid |
$160.68
|
| Rate for Payer: EmblemHealth Medicare |
$68.29
|
| Rate for Payer: EmblemHealth Select Care |
$144.61
|
| Rate for Payer: Fidelis Medicare |
$80.34
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.34
|
| Rate for Payer: Humana Medicare |
$80.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.13
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$80.34
|
| Rate for Payer: WellCare Medicare |
$110.47
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (MOD 59 W KX)
|
Facility
|
IP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO,59,KX
|
| Hospital Charge Code |
4650435
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$130.55 |
| Max. Negotiated Rate |
$130.55 |
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (MOD 59 W KX)
|
Facility
|
OP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO,59,KX
|
| Hospital Charge Code |
4650435
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.34
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: CDPHP Medicare |
$74.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.68
|
| Rate for Payer: EmblemHealth Medicaid |
$160.68
|
| Rate for Payer: EmblemHealth Medicare |
$68.29
|
| Rate for Payer: EmblemHealth Select Care |
$144.61
|
| Rate for Payer: Fidelis Medicare |
$80.34
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.34
|
| Rate for Payer: Humana Medicare |
$80.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.13
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$80.34
|
| Rate for Payer: WellCare Medicare |
$110.47
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (W/ KX)
|
Facility
|
IP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO,KX
|
| Hospital Charge Code |
4650328
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$130.55 |
| Max. Negotiated Rate |
$130.55 |
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
|
|
OT AS PART OF P HOSP/DAY PER SESS 45+ MI (W/ KX)
|
Facility
|
OP
|
$200.85
|
|
|
Service Code
|
HCPCS G0129 GO,KX
|
| Hospital Charge Code |
4650328
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.34
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: Cash Price |
$150.64
|
| Rate for Payer: CDPHP Medicare |
$74.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.68
|
| Rate for Payer: EmblemHealth Medicaid |
$160.68
|
| Rate for Payer: EmblemHealth Medicare |
$68.29
|
| Rate for Payer: EmblemHealth Select Care |
$144.61
|
| Rate for Payer: Fidelis Medicare |
$80.34
|
| Rate for Payer: Galaxy Health Commercial |
$130.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.34
|
| Rate for Payer: Humana Medicare |
$80.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.13
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$80.34
|
| Rate for Payer: WellCare Medicare |
$110.47
|
|
