|
OTM ELASTOMER
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41802400
|
|
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
|
|
|
OTM E-STIM(MANUAL ATTENDED) 15MTS
|
Facility
|
OP
|
$42.63
|
|
|
Service Code
|
HCPCS 97032 GO
|
| Hospital Charge Code |
41804478
|
|
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
|
|
|
OTM E-STIM (UNATTENDED)
|
Facility
|
OP
|
$32.60
|
|
|
Service Code
|
HCPCS 97014 GO
|
| Hospital Charge Code |
41804470
|
|
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
|
|
|
OTM EXTENDED SHOE HORN
|
Facility
|
OP
|
$13.47
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804532
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
OTM FINGER EXTENSION SPRING
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
41804390
|
|
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
|
|
|
OTM FINGER EXT & SPRING
|
Facility
|
OP
|
$65.21
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
41804093
|
|
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
|
|
|
OTM FINGER EXT & WRIST SUPPORT
|
Facility
|
OP
|
$285.27
|
|
|
Service Code
|
HCPCS L3931
|
| Hospital Charge Code |
41804094
|
|
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
|
|
|
OTM FLEXION GLOVE
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS L3912
|
| Hospital Charge Code |
41804065
|
|
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
|
|
|
OTM FULL ARM LATERAL
|
Facility
|
OP
|
$277.13
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
41803300
|
|
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 |
$138.56
|
| Rate for Payer: Aetna Government |
$138.56
|
| 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
|
|
|
OTM FUNCTIONAL PERFORMANCE 15 MTS
|
Facility
|
OP
|
$116.13
|
|
|
Service Code
|
HCPCS 97530 GO
|
| Hospital Charge Code |
41804498
|
|
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
|
|
|
OTM HFO NONTORSION JOINT PREFAB
|
Facility
|
OP
|
$40.75
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
41804092
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$42.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.50
|
| Rate for Payer: Aetna Government |
$37.50
|
| Rate for Payer: Brighton Health Commercial |
$24.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.43
|
| Rate for Payer: EmblemHealth Commercial |
$20.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.79
|
| Rate for Payer: Group Health Inc Commercial |
$20.38
|
| Rate for Payer: Group Health Inc Medicare |
$14.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.49
|
|
|
OTM HIP KIT ISSUE TRAINING
|
Facility
|
OP
|
$122.26
|
|
|
Service Code
|
HCPCS E1399
|
| Hospital Charge Code |
41804060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$97.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.13
|
| Rate for Payer: Aetna Government |
$61.13
|
| Rate for Payer: Brighton Health Commercial |
$91.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.14
|
| Rate for Payer: Group Health Inc Commercial |
$61.13
|
| Rate for Payer: Group Health Inc Medicare |
$42.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.13
|
|
|
OTM HOT/COLD PACKS
|
Facility
|
OP
|
$36.86
|
|
|
Service Code
|
HCPCS 97010 GO
|
| Hospital Charge Code |
41804468
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.75
|
| Rate for Payer: Aetna Government |
$3.75
|
| 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 |
$18.43
|
| 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 |
$18.43
|
| 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
|
|
|
OTM IISOTONER GLOVE
|
Facility
|
OP
|
$16.31
|
|
|
Service Code
|
HCPCS S8427
|
| Hospital Charge Code |
41804080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.66
|
| Rate for Payer: Aetna Government |
$3.66
|
| Rate for Payer: Brighton Health Commercial |
$12.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.09
|
| Rate for Payer: Group Health Inc Commercial |
$8.16
|
| Rate for Payer: Group Health Inc Medicare |
$5.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.16
|
|
|
OTM IONTOPHORESIS 15 MTS
|
Facility
|
OP
|
$60.78
|
|
|
Service Code
|
HCPCS 97033 GO
|
| Hospital Charge Code |
41804479
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.94
|
| Rate for Payer: Aetna Government |
$15.94
|
| 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 |
$30.39
|
| 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 |
$30.39
|
| 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
|
|
|
OTM KLEINERT'S TRACTION
|
Facility
|
OP
|
$326.03
|
|
|
Service Code
|
HCPCS L3931
|
| Hospital Charge Code |
41804260
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.61 |
| Max. Negotiated Rate |
$342.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.61
|
| Rate for Payer: Aetna Government |
$91.61
|
| Rate for Payer: Brighton Health Commercial |
$195.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$163.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.47
|
| Rate for Payer: EmblemHealth Commercial |
$163.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.33
|
| Rate for Payer: Group Health Inc Commercial |
$163.02
|
| Rate for Payer: Group Health Inc Medicare |
$114.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.92
|
|
|
OTM LIPPED PLATE
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$11.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$10.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.64
|
| Rate for Payer: Group Health Inc Commercial |
$7.09
|
| Rate for Payer: Group Health Inc Medicare |
$4.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.09
|
|
|
OTM MANUAL THERAPY TECHNIQUE 15MT
|
Facility
|
OP
|
$81.83
|
|
|
Service Code
|
HCPCS 97140 GO
|
| Hospital Charge Code |
41804494
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.78
|
| Rate for Payer: Aetna Government |
$17.78
|
| 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 |
$40.92
|
| 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 |
$40.92
|
| 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
|
|
|
OTM MASSAGE 15 MTS
|
Facility
|
OP
|
$85.48
|
|
|
Service Code
|
HCPCS 97124 GO
|
| Hospital Charge Code |
41804492
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.74
|
| Rate for Payer: Aetna Government |
$15.74
|
| 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 |
$42.74
|
| 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 |
$42.74
|
| 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
|
|
|
OTM MP/PIP/BLOCKERS
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS S8450
|
| Hospital Charge Code |
41804380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$51.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.14
|
| Rate for Payer: Aetna Government |
$9.14
|
| 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
|
|
|
OTM NEUROMUSCULAR RE-EDUCAT.15MTS
|
Facility
|
OP
|
$102.45
|
|
|
Service Code
|
HCPCS 97112 GO
|
| Hospital Charge Code |
41804489
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.29
|
| Rate for Payer: Aetna Government |
$20.29
|
| 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 |
$51.22
|
| 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 |
$51.22
|
| 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
|
|
|
OTM NON-SKID MATERIAL
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804529
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$71.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$66.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.72
|
| Rate for Payer: Group Health Inc Commercial |
$44.65
|
| Rate for Payer: Group Health Inc Medicare |
$31.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.65
|
|
|
OTM NOSEY CUP
|
Facility
|
OP
|
$8.51
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41804522
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$6.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
|
|
OTM ORTHO. PROSTHETIC CKOUT 15MTS
|
Facility
|
OP
|
$156.48
|
|
|
Service Code
|
HCPCS 97763
|
| Hospital Charge Code |
41804504
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.79
|
| Rate for Payer: Aetna Government |
$42.79
|
| 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: Group Health Inc Commercial |
$78.24
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OTM ORTHOTIC F/T EXTREMETIES 15MT
|
Facility
|
OP
|
$145.48
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
41804496
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.95
|
| Rate for Payer: Aetna Government |
$22.95
|
| 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 |
$72.74
|
| 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 |
$72.74
|
| 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
|
|
