|
OT WHIRLPOOL THERAPY 1+ AREAS (MOD 59)
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GO,59
|
| Hospital Charge Code |
4690211
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.20
|
| 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 |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$46.08
|
| Rate for Payer: Fidelis Medicare |
$25.60
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.60
|
| Rate for Payer: Humana Medicare |
$25.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| 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 |
$26.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$25.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
OT WHIRLPOOL THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GO,59,KX
|
| Hospital Charge Code |
4690242
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
OT WHIRLPOOL THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GO,59,KX
|
| Hospital Charge Code |
4690242
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.20
|
| 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 |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$46.08
|
| Rate for Payer: Fidelis Medicare |
$25.60
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.60
|
| Rate for Payer: Humana Medicare |
$25.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| 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 |
$26.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$25.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
OT WHIRLPOOL THERAPY 1+ AREAS (W/ KX)
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GO,KX
|
| Hospital Charge Code |
4690176
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: CDPHP Medicare |
$23.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$51.20
|
| 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 |
$21.76
|
| Rate for Payer: EmblemHealth Select Care |
$46.08
|
| Rate for Payer: Fidelis Medicare |
$25.60
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$21.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$25.60
|
| Rate for Payer: Humana Medicare |
$25.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.44
|
| 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 |
$26.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$25.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.54
|
| Rate for Payer: WellCare Medicare |
$35.20
|
|
|
OT WHIRLPOOL THERAPY 1+ AREAS (W/ KX)
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 97022 GO,KX
|
| Hospital Charge Code |
4690176
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Galaxy Health Commercial |
$41.60
|
|
|
OT WND CARE ELEC STIM UA, STAGE 3-4 ULCERS
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO
|
| Hospital Charge Code |
4690005
|
|
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 WND CARE ELEC STIM UA, STAGE 3-4 ULCERS
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO
|
| Hospital Charge Code |
4690005
|
|
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 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| 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: 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 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 |
$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 Medicare |
$26.95
|
|
|
OT WND CARE ELEC STIM UA, STAGE 3-4 ULCERS (MOD 59)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO,59
|
| Hospital Charge Code |
4690208
|
|
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 WND CARE ELEC STIM UA, STAGE 3-4 ULCERS (MOD 59)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO,59
|
| Hospital Charge Code |
4690208
|
|
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 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| 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: 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 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 |
$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 Medicare |
$26.95
|
|
|
OT WND CARE ELEC STIM UA, STAGE 3-4 ULCERS (MOD 59 W KX)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO,59,KX
|
| Hospital Charge Code |
4690239
|
|
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 WND CARE ELEC STIM UA, STAGE 3-4 ULCERS (MOD 59 W KX)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO,59,KX
|
| Hospital Charge Code |
4690239
|
|
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 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| 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: 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 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 |
$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 Medicare |
$26.95
|
|
|
OT WND CARE ELEC STIM UA, STAGE 3-4 ULCERS (W/ KX)
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO,KX
|
| Hospital Charge Code |
4690173
|
|
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 |
$39.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$39.20
|
| Rate for Payer: EmblemHealth Medicaid |
$39.20
|
| 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: 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 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 |
$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 Medicare |
$26.95
|
|
|
OT WND CARE ELEC STIM UA, STAGE 3-4 ULCERS (W/ KX)
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS G0281 GO,KX
|
| Hospital Charge Code |
4690173
|
|
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 WORK HARDENING INIT 2 HRS
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO
|
| Hospital Charge Code |
4690023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
OT WORK HARDENING INIT 2 HRS
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO
|
| Hospital Charge Code |
4690023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
OT WORK HARDENING INIT 2 HRS (MOD 59)
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO,59
|
| Hospital Charge Code |
4690225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
OT WORK HARDENING INIT 2 HRS (MOD 59)
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO,59
|
| Hospital Charge Code |
4690225
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
OT WORK HARDENING INIT 2 HRS (MOD 59 W KX)
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO,59,KX
|
| Hospital Charge Code |
4690256
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
OT WORK HARDENING INIT 2 HRS (MOD 59 W KX)
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO,59,KX
|
| Hospital Charge Code |
4690256
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
OT WORK HARDENING INIT 2 HRS (W/ KX)
|
Facility
|
IP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO,KX
|
| Hospital Charge Code |
4690190
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
|
|
OT WORK HARDENING INIT 2 HRS (W/ KX)
|
Facility
|
OP
|
$140.08
|
|
|
Service Code
|
HCPCS 97545 GO,KX
|
| Hospital Charge Code |
4690190
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$316.05 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.03
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: Cash Price |
$105.06
|
| Rate for Payer: CDPHP Medicare |
$51.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$112.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$176.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$147.00
|
| Rate for Payer: EmblemHealth Medicaid |
$147.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.63
|
| Rate for Payer: EmblemHealth Select Care |
$100.86
|
| Rate for Payer: Fidelis Medicare |
$56.03
|
| Rate for Payer: Galaxy Health Commercial |
$91.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$144.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.03
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$154.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$316.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.01
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$56.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$154.35
|
| Rate for Payer: WellCare Medicare |
$77.04
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO
|
| Hospital Charge Code |
4690027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| 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 |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO
|
| Hospital Charge Code |
4690027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59)
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO,59
|
| Hospital Charge Code |
4690229
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$399.75 |
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
|
|
OT WOUND(S) CARE NON-SELECTIVE,PER SESSION (MOD 59)
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 97602 GO,59
|
| Hospital Charge Code |
4690229
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$282.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$246.00
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: Cash Price |
$461.25
|
| Rate for Payer: CDPHP Medicare |
$227.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.00
|
| Rate for Payer: EmblemHealth Medicaid |
$492.00
|
| Rate for Payer: EmblemHealth Medicare |
$209.10
|
| Rate for Payer: EmblemHealth Select Care |
$442.80
|
| Rate for Payer: Fidelis Medicare |
$246.00
|
| Rate for Payer: Galaxy Health Commercial |
$399.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$246.00
|
| Rate for Payer: Humana Medicare |
$246.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$282.90
|
| 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 |
$258.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$246.00
|
| Rate for Payer: WellCare Medicare |
$338.25
|
|
