|
OT DYNAMIC WRIST EXTENSION
|
Facility
|
OP
|
$260.82
|
|
|
Service Code
|
HCPCS L3931
|
| Hospital Charge Code |
41809280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.29 |
| Max. Negotiated Rate |
$273.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.61
|
| Rate for Payer: Aetna Government |
$91.61
|
| Rate for Payer: Brighton Health Commercial |
$156.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.97
|
| Rate for Payer: EmblemHealth Commercial |
$130.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.86
|
| Rate for Payer: Group Health Inc Commercial |
$130.41
|
| Rate for Payer: Group Health Inc Medicare |
$91.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.53
|
|
|
OT ELASTIC SHOE LACES
|
Facility
|
OP
|
$7.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809535
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$5.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Medicare |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.54
|
|
|
OT ELASTIC WRIST SUPPORT
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS 99070
|
| Hospital Charge Code |
41806900
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.26
|
| Rate for Payer: Aetna Government |
$10.26
|
| Rate for Payer: Brighton Health Commercial |
$36.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.26
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
|
|
OT ELASTOMER
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$36.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.26
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
|
|
OT E-STIM (MANUAL ATTENDED)15 MTS
|
Facility
|
OP
|
$42.63
|
|
|
Service Code
|
HCPCS 97032 GO
|
| Hospital Charge Code |
41809478
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$65.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$65.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.02
|
| Rate for Payer: Amida Care Medicaid |
$29.02
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,902.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.47
|
| Rate for Payer: Group Health Inc Commercial |
$21.32
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Healthfirst Essential Plan |
$65.30
|
| Rate for Payer: Healthfirst QHP |
$29.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.02
|
| Rate for Payer: SOMOS Essential |
$65.30
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$65.30
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$31.92
|
| Rate for Payer: United Healthcare Medicaid |
$29.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT E-STIM (UNATTENDED)
|
Facility
|
OP
|
$32.60
|
|
|
Service Code
|
HCPCS 97014 GO
|
| Hospital Charge Code |
41809470
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.69
|
| Rate for Payer: Aetna Government |
$9.69
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$65.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$65.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.02
|
| Rate for Payer: Amida Care Medicaid |
$29.02
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,902.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.47
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Healthfirst Essential Plan |
$65.30
|
| Rate for Payer: Healthfirst QHP |
$29.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.02
|
| Rate for Payer: SOMOS Essential |
$65.30
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$65.30
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$31.92
|
| Rate for Payer: United Healthcare Medicaid |
$29.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT EVAL HIGH COMPLEX 60 MIN
|
Facility
|
OP
|
$264.30
|
|
|
Service Code
|
HCPCS 97167 GO
|
| Hospital Charge Code |
41809579
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$17,128.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$145.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.55
|
| Rate for Payer: Aetna Government |
$47.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$385.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$385.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$171.28
|
| Rate for Payer: Amida Care Medicaid |
$171.28
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,128.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.84
|
| Rate for Payer: Group Health Inc Commercial |
$132.15
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.28
|
| Rate for Payer: Healthfirst Essential Plan |
$385.38
|
| Rate for Payer: Healthfirst QHP |
$171.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.28
|
| Rate for Payer: SOMOS Essential |
$385.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$385.38
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$188.41
|
| Rate for Payer: United Healthcare Medicaid |
$171.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$171.28
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT EVAL LOW COMPLEX 30 MIN
|
Facility
|
OP
|
$265.38
|
|
|
Service Code
|
HCPCS 97165 GO
|
| Hospital Charge Code |
41809581
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$10,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$145.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.55
|
| Rate for Payer: Aetna Government |
$47.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$231.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$231.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$102.78
|
| Rate for Payer: Amida Care Medicaid |
$102.78
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.92
|
| Rate for Payer: Group Health Inc Commercial |
$132.69
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.78
|
| Rate for Payer: Healthfirst Essential Plan |
$231.26
|
| Rate for Payer: Healthfirst QHP |
$102.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.78
|
| Rate for Payer: SOMOS Essential |
$231.26
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$231.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$113.06
|
| Rate for Payer: United Healthcare Medicaid |
$102.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$102.78
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT EVAL MOD COMPLEX 45 MIN
|
Facility
|
OP
|
$264.30
|
|
|
Service Code
|
HCPCS 97166 GO
|
| Hospital Charge Code |
41809578
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$13,703.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$145.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.55
|
| Rate for Payer: Aetna Government |
$47.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$308.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$308.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$137.03
|
| Rate for Payer: Amida Care Medicaid |
$137.03
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,703.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.88
|
| Rate for Payer: Group Health Inc Commercial |
$132.15
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.03
|
| Rate for Payer: Healthfirst Essential Plan |
$308.32
|
| Rate for Payer: Healthfirst QHP |
$137.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.03
|
| Rate for Payer: SOMOS Essential |
$308.32
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$308.32
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$150.73
|
| Rate for Payer: United Healthcare Medicaid |
$137.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.03
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT EXTENDED SHOE HORN
|
Facility
|
OP
|
$13.47
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809532
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$10.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.74
|
| Rate for Payer: Group Health Inc Medicare |
$4.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.74
|
|
|
OT FINGER EXTENSION SPRING
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
41809390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$51.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.50
|
| Rate for Payer: Aetna Government |
$37.50
|
| Rate for Payer: Brighton Health Commercial |
$29.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$24.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.36
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
|
OT FINGER EXT & SPRING
|
Facility
|
OP
|
$65.21
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
41808093
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$68.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.68
|
| Rate for Payer: Aetna Government |
$23.68
|
| Rate for Payer: Brighton Health Commercial |
$39.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.50
|
| Rate for Payer: EmblemHealth Commercial |
$32.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.47
|
| Rate for Payer: Group Health Inc Commercial |
$32.60
|
| Rate for Payer: Group Health Inc Medicare |
$22.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.39
|
|
|
OT FINGER EXT & WRIST SUPPORT
|
Facility
|
OP
|
$285.27
|
|
|
Service Code
|
HCPCS L3931
|
| Hospital Charge Code |
41808094
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.61 |
| Max. Negotiated Rate |
$299.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.61
|
| Rate for Payer: Aetna Government |
$91.61
|
| Rate for Payer: Brighton Health Commercial |
$171.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$142.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.03
|
| Rate for Payer: EmblemHealth Commercial |
$142.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$299.53
|
| Rate for Payer: Group Health Inc Commercial |
$142.64
|
| Rate for Payer: Group Health Inc Medicare |
$99.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.43
|
|
|
OT FLEXION GLOVE
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS L3912
|
| Hospital Charge Code |
41808065
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$51.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.50
|
| Rate for Payer: Aetna Government |
$45.50
|
| Rate for Payer: Brighton Health Commercial |
$29.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$24.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.36
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
|
OT FLUIDOTHERAPY
|
Facility
|
OP
|
$53.30
|
|
|
Service Code
|
HCPCS 97022
|
| Hospital Charge Code |
41809540
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.37
|
| Rate for Payer: Aetna Government |
$14.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$65.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$65.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.02
|
| Rate for Payer: Amida Care Medicaid |
$29.02
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,902.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.47
|
| Rate for Payer: Group Health Inc Commercial |
$26.65
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Healthfirst Essential Plan |
$65.30
|
| Rate for Payer: Healthfirst QHP |
$29.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.02
|
| Rate for Payer: SOMOS Essential |
$65.30
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$65.30
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$31.92
|
| Rate for Payer: United Healthcare Medicaid |
$29.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT FULL ARM LATERAL
|
Facility
|
OP
|
$277.13
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
41809300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$290.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.97
|
| Rate for Payer: Aetna Government |
$188.97
|
| Rate for Payer: Brighton Health Commercial |
$166.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.35
|
| Rate for Payer: EmblemHealth Commercial |
$138.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$290.99
|
| Rate for Payer: Group Health Inc Commercial |
$138.56
|
| Rate for Payer: Group Health Inc Medicare |
$97.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.13
|
|
|
OT FUNCTIONAL PERFORMANCE 15MTS
|
Facility
|
OP
|
$116.13
|
|
|
Service Code
|
HCPCS 97530 GO
|
| Hospital Charge Code |
41809498
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.87
|
| Rate for Payer: Aetna Government |
$20.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.88
|
| Rate for Payer: Amida Care Medicaid |
$47.88
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,788.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.27
|
| Rate for Payer: Group Health Inc Commercial |
$58.06
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Healthfirst Essential Plan |
$107.73
|
| Rate for Payer: Healthfirst QHP |
$47.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.88
|
| Rate for Payer: SOMOS Essential |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$107.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52.67
|
| Rate for Payer: United Healthcare Medicaid |
$47.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT GAIT TRAINING 15 MTS
|
Facility
|
OP
|
$88.03
|
|
|
Service Code
|
HCPCS 97116 GO
|
| Hospital Charge Code |
41809491
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.96
|
| Rate for Payer: Aetna Government |
$16.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.88
|
| Rate for Payer: Amida Care Medicaid |
$47.88
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,788.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.27
|
| Rate for Payer: Group Health Inc Commercial |
$44.02
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Healthfirst Essential Plan |
$107.73
|
| Rate for Payer: Healthfirst QHP |
$47.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.88
|
| Rate for Payer: SOMOS Essential |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$107.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52.67
|
| Rate for Payer: United Healthcare Medicaid |
$47.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$37,363.48
|
|
|
Service Code
|
MSDRG 818
|
| Min. Negotiated Rate |
$10,059.30 |
| Max. Negotiated Rate |
$37,363.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,297.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,173.44
|
| Rate for Payer: Aetna Government |
$27,173.44
|
| Rate for Payer: Brighton Health Commercial |
$17,009.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,716.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,713.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,394.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,814.77
|
| Rate for Payer: EmblemHealth Commercial |
$10,059.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,173.44
|
| Rate for Payer: Group Health Inc Commercial |
$27,173.44
|
| Rate for Payer: Group Health Inc Medicare |
$27,173.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,173.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,635.65
|
| Rate for Payer: Humana Medicare |
$37,363.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,173.44
|
| Rate for Payer: United Healthcare Commercial |
$28,460.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,173.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,173.44
|
| Rate for Payer: Wellcare Medicare |
$25,814.77
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$63,785.54
|
|
|
Service Code
|
MSDRG 817
|
| Min. Negotiated Rate |
$19,336.60 |
| Max. Negotiated Rate |
$63,785.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,249.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46,389.48
|
| Rate for Payer: Aetna Government |
$46,389.48
|
| Rate for Payer: Brighton Health Commercial |
$32,697.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47,317.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48,643.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40,142.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$44,070.01
|
| Rate for Payer: EmblemHealth Commercial |
$19,336.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$46,389.48
|
| Rate for Payer: Group Health Inc Commercial |
$46,389.48
|
| Rate for Payer: Group Health Inc Medicare |
$46,389.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46,389.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,571.11
|
| Rate for Payer: Humana Medicare |
$63,785.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46,389.48
|
| Rate for Payer: United Healthcare Commercial |
$56,017.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,389.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46,389.48
|
| Rate for Payer: Wellcare Medicare |
$44,070.01
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,373.98
|
|
|
Service Code
|
MSDRG 819
|
| Min. Negotiated Rate |
$7,779.24 |
| Max. Negotiated Rate |
$27,373.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,376.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,908.35
|
| Rate for Payer: Aetna Government |
$19,908.35
|
| Rate for Payer: Brighton Health Commercial |
$13,154.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,306.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,666.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,928.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,912.93
|
| Rate for Payer: EmblemHealth Commercial |
$7,779.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,908.35
|
| Rate for Payer: Group Health Inc Commercial |
$19,908.35
|
| Rate for Payer: Group Health Inc Medicare |
$19,908.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,908.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,257.38
|
| Rate for Payer: Humana Medicare |
$27,373.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,908.35
|
| Rate for Payer: United Healthcare Commercial |
$18,041.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,908.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,908.35
|
| Rate for Payer: Wellcare Medicare |
$18,912.93
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$24,141.99
|
|
|
Service Code
|
MSDRG 832
|
| Min. Negotiated Rate |
$6,325.78 |
| Max. Negotiated Rate |
$24,141.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,877.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,557.81
|
| Rate for Payer: Aetna Government |
$17,557.81
|
| Rate for Payer: Brighton Health Commercial |
$10,696.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,908.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,739.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,513.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,679.92
|
| Rate for Payer: EmblemHealth Commercial |
$6,325.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,557.81
|
| Rate for Payer: Group Health Inc Commercial |
$17,557.81
|
| Rate for Payer: Group Health Inc Medicare |
$17,557.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,557.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,164.38
|
| Rate for Payer: Humana Medicare |
$24,141.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,557.81
|
| Rate for Payer: United Healthcare Commercial |
$14,670.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,557.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,557.81
|
| Rate for Payer: Wellcare Medicare |
$16,679.92
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$30,579.23
|
|
|
Service Code
|
MSDRG 831
|
| Min. Negotiated Rate |
$8,659.04 |
| Max. Negotiated Rate |
$30,579.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,889.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,239.44
|
| Rate for Payer: Aetna Government |
$22,239.44
|
| Rate for Payer: Brighton Health Commercial |
$14,642.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,684.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,569.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,324.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,127.47
|
| Rate for Payer: EmblemHealth Commercial |
$8,659.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,239.44
|
| Rate for Payer: Group Health Inc Commercial |
$22,239.44
|
| Rate for Payer: Group Health Inc Medicare |
$22,239.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,239.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,341.34
|
| Rate for Payer: Humana Medicare |
$30,579.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,239.44
|
| Rate for Payer: United Healthcare Commercial |
$21,384.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,239.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,239.44
|
| Rate for Payer: Wellcare Medicare |
$21,127.47
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,834.58
|
|
|
Service Code
|
MSDRG 833
|
| Min. Negotiated Rate |
$4,388.69 |
| Max. Negotiated Rate |
$19,834.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,546.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14,425.15
|
| Rate for Payer: Aetna Government |
$14,425.15
|
| Rate for Payer: Brighton Health Commercial |
$7,421.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14,713.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,838.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,293.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$13,703.89
|
| Rate for Payer: EmblemHealth Commercial |
$4,388.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,425.15
|
| Rate for Payer: Group Health Inc Commercial |
$14,425.15
|
| Rate for Payer: Group Health Inc Medicare |
$14,425.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,425.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,707.69
|
| Rate for Payer: Humana Medicare |
$19,834.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14,425.15
|
| Rate for Payer: United Healthcare Commercial |
$10,178.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,425.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,425.15
|
| Rate for Payer: Wellcare Medicare |
$13,703.89
|
|
|
OTHER CARDIOTHORACIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$106,151.97
|
|
|
Service Code
|
MSDRG 228
|
| Min. Negotiated Rate |
$35,898.66 |
| Max. Negotiated Rate |
$106,151.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74,295.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77,201.43
|
| Rate for Payer: Aetna Government |
$77,201.43
|
| Rate for Payer: Brighton Health Commercial |
$73,061.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78,745.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87,013.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$71,807.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$73,341.36
|
| Rate for Payer: EmblemHealth Commercial |
$43,206.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$77,201.43
|
| Rate for Payer: Group Health Inc Commercial |
$77,201.43
|
| Rate for Payer: Group Health Inc Medicare |
$77,201.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77,201.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35,898.66
|
| Rate for Payer: Humana Medicare |
$106,151.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77,201.43
|
| Rate for Payer: United Healthcare Commercial |
$100,204.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77,201.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77,201.43
|
| Rate for Payer: Wellcare Medicare |
$73,341.36
|
|
