|
OT NEUROMUSCULAR REEDUCATION EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GO,KX
|
| Hospital Charge Code |
4690181
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
OT NEUROMUSCULAR REEDUCATION EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GO,KX
|
| Hospital Charge Code |
4650352
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
OT NEUROMUSCULAR REEDUCATION EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 97112 GO,KX
|
| Hospital Charge Code |
4650352
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.80
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$54.80
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.80
|
| Rate for Payer: Humana Medicare |
$54.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.51
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$57.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$20.55
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$54.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
OT NON WND ELECT STIM
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO
|
| Hospital Charge Code |
4690006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
OT NON WND ELECT STIM
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO
|
| Hospital Charge Code |
4690006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
|
|
OT NON WND ELECT STIM (MOD 59)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO,59
|
| Hospital Charge Code |
4690209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
OT NON WND ELECT STIM (MOD 59)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO,59
|
| Hospital Charge Code |
4690209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
|
|
OT NON WND ELECT STIM (MOD 59 W KX)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO,59,KX
|
| Hospital Charge Code |
4690240
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
|
|
OT NON WND ELECT STIM (MOD 59 W KX)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO,59,KX
|
| Hospital Charge Code |
4690240
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
OT NON WND ELECT STIM (W/ KX)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO,KX
|
| Hospital Charge Code |
4690174
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.60
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: CDPHP Medicare |
$18.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.42
|
| Rate for Payer: EmblemHealth Medicaid |
$22.42
|
| Rate for Payer: EmblemHealth Medicare |
$16.66
|
| Rate for Payer: EmblemHealth Select Care |
$35.28
|
| Rate for Payer: Fidelis Medicare |
$19.60
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.60
|
| Rate for Payer: Humana Medicare |
$19.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.54
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$19.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$26.95
|
|
|
OT NON WND ELECT STIM (W/ KX)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0283 GO,KX
|
| Hospital Charge Code |
4690174
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Galaxy Health Commercial |
$31.85
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO
|
| Hospital Charge Code |
4650126
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO
|
| Hospital Charge Code |
4690025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO
|
| Hospital Charge Code |
4650126
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO
|
| Hospital Charge Code |
4690025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59
|
| Hospital Charge Code |
4650405
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59
|
| Hospital Charge Code |
4650405
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59
|
| Hospital Charge Code |
4690227
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59
|
| Hospital Charge Code |
4690227
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59,KX
|
| Hospital Charge Code |
4650457
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59,KX
|
| Hospital Charge Code |
4690258
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59,KX
|
| Hospital Charge Code |
4650457
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (MOD 59 W KX)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,59,KX
|
| Hospital Charge Code |
4690258
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (W/ KX)
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,KX
|
| Hospital Charge Code |
4690192
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$82.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.60
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: CDPHP Medicare |
$66.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$143.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.98
|
| Rate for Payer: EmblemHealth Medicaid |
$36.98
|
| Rate for Payer: EmblemHealth Medicare |
$60.86
|
| Rate for Payer: EmblemHealth Select Care |
$128.88
|
| Rate for Payer: Fidelis Medicare |
$71.60
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.60
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.34
|
| 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 |
$75.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.85
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$71.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.83
|
| Rate for Payer: WellCare Medicare |
$98.45
|
|
|
OT ORTHOTIC MGMT AND TRAINING EA 15 MINS (W/ KX)
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 97760 GO,KX
|
| Hospital Charge Code |
4690192
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Cash Price |
$134.25
|
| Rate for Payer: Galaxy Health Commercial |
$116.35
|
|
