|
OTOPLASTY, PROTRUDING EAR
|
Facility
|
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 69300
|
| Hospital Charge Code |
40014247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,949.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,606.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,606.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,606.26
|
| Rate for Payer: Brighton Health Commercial |
$5,949.88
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Humana Medicare |
$3,797.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
OTOPLASTY, PROTRUDING EAR
|
Facility
|
IP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 69300
|
| Hospital Charge Code |
40014247
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,723.23
|
|
|
OT ORTHOTIC F/T- EXTREMETIES 15MT
|
Facility
|
OP
|
$145.48
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
41809496
|
|
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
|
|
|
OT ORTHOTIC PROSTHETIC CKOUT 15MT
|
Facility
|
OP
|
$156.48
|
|
|
Service Code
|
HCPCS 97763
|
| Hospital Charge Code |
41809504
|
|
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
|
|
|
OT PARAFFIN BATH
|
Facility
|
OP
|
$18.10
|
|
|
Service Code
|
HCPCS 97018 GO
|
| Hospital Charge Code |
41809472
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.85
|
| Rate for Payer: Aetna Government |
$6.85
|
| 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 |
$9.05
|
| 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 |
$9.05
|
| 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 PHYSICAL PERFORMANCE TEST 15MT
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 97750 GO
|
| Hospital Charge Code |
41809505
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.85
|
| Rate for Payer: Aetna Government |
$19.85
|
| 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 |
$51.00
|
| 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 |
$51.00
|
| 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 PLATE GUARD
|
Facility
|
OP
|
$12.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809520
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$9.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.68
|
| Rate for Payer: Group Health Inc Commercial |
$6.38
|
| Rate for Payer: Group Health Inc Medicare |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.38
|
|
|
OT PROSTHETIC TRAIN-EXTRE 15MTS
|
Facility
|
OP
|
$122.90
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
41809497
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.85
|
| Rate for Payer: Aetna Government |
$19.85
|
| 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 |
$61.45
|
| 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 |
$61.45
|
| 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 REACHER
|
Facility
|
OP
|
$26.93
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809530
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$20.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.31
|
| Rate for Payer: Group Health Inc Commercial |
$13.46
|
| Rate for Payer: Group Health Inc Medicare |
$9.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.46
|
|
|
OT RE-EVALUATION
|
Facility
|
OP
|
$183.80
|
|
|
Service Code
|
HCPCS 97168 GO
|
| Hospital Charge Code |
41809580
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$10,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.45
|
| Rate for Payer: Aetna Government |
$31.45
|
| 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 |
$91.90
|
| 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 |
$91.90
|
| 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 REEVALUATION
|
Facility
|
OP
|
$183.80
|
|
|
Service Code
|
HCPCS 97168 GO
|
| Hospital Charge Code |
41809467
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$10,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.45
|
| Rate for Payer: Aetna Government |
$31.45
|
| 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 |
$91.90
|
| 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 |
$91.90
|
| 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 RESTING HAND SPLINT
|
Facility
|
OP
|
$326.03
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
41806100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$342.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.89
|
| Rate for Payer: Aetna Government |
$195.89
|
| 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
|
|
|
OT RESTING SPLINT
|
Facility
|
OP
|
$570.55
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
41802950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$599.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.32
|
| Rate for Payer: Aetna Government |
$38.32
|
| Rate for Payer: Brighton Health Commercial |
$342.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$285.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$328.07
|
| Rate for Payer: EmblemHealth Commercial |
$285.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$599.08
|
| Rate for Payer: Group Health Inc Commercial |
$285.28
|
| Rate for Payer: Group Health Inc Medicare |
$199.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.86
|
|
|
OT ROM -EACH EXTREMITY/TRUNK
|
Facility
|
OP
|
$23.33
|
|
|
Service Code
|
HCPCS 95851 GO
|
| Hospital Charge Code |
41809508
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.18
|
| Rate for Payer: Aetna Government |
$16.18
|
| 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 |
$11.66
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.66
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT ROM- HAND
|
Facility
|
OP
|
$17.48
|
|
|
Service Code
|
HCPCS 95852 GO
|
| Hospital Charge Code |
41809509
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| 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 |
$8.74
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.74
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT SCAR MANAGEMENT TOOL
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
41809541
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| 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 |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT SELF ADHERENT BANDAGE > 5 IN
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
HCPCS A6456
|
| Hospital Charge Code |
41809575
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna Government |
$0.77
|
| Rate for Payer: Brighton Health Commercial |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.82
|
| Rate for Payer: Group Health Inc Commercial |
$1.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.34
|
|
|
OT SENSORY INTEGRATIVE TECHNIQUES
|
Facility
|
OP
|
$153.25
|
|
|
Service Code
|
HCPCS 97533
|
| Hospital Charge Code |
41809519
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$5,078.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.32
|
| Rate for Payer: Aetna Government |
$17.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$114.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$114.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.78
|
| Rate for Payer: Amida Care Medicaid |
$50.78
|
| 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 |
$5,078.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.32
|
| Rate for Payer: Group Health Inc Commercial |
$76.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.78
|
| Rate for Payer: Healthfirst Essential Plan |
$114.26
|
| Rate for Payer: Healthfirst QHP |
$50.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.78
|
| Rate for Payer: SOMOS Essential |
$114.26
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$114.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55.86
|
| Rate for Payer: United Healthcare Medicaid |
$50.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.78
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT SERPENTINE FINGER BASED SPLINT
|
Facility
|
OP
|
$57.06
|
|
|
Service Code
|
HCPCS S8450
|
| Hospital Charge Code |
41806650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$59.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.14
|
| Rate for Payer: Aetna Government |
$9.14
|
| Rate for Payer: Brighton Health Commercial |
$34.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.81
|
| Rate for Payer: EmblemHealth Commercial |
$28.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.91
|
| Rate for Payer: Group Health Inc Commercial |
$28.53
|
| Rate for Payer: Group Health Inc Medicare |
$19.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.09
|
|
|
OT SKIN BARRIER,WIPES,ORSWABS,EA
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
41809562
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
OT SLING
|
Facility
|
OP
|
$16.31
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
41808061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.68
|
| Rate for Payer: Aetna Government |
$4.68
|
| 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
|
|
|
OT SOCK AID
|
Facility
|
OP
|
$14.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809534
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$11.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.13
|
| Rate for Payer: Group Health Inc Commercial |
$7.44
|
| Rate for Payer: Group Health Inc Medicare |
$5.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.44
|
|
|
OT SPOUT CUP
|
Facility
|
OP
|
$19.85
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809525
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$14.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.50
|
| Rate for Payer: Group Health Inc Commercial |
$9.92
|
| Rate for Payer: Group Health Inc Medicare |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
|
|
OT STATIC PIP EXTENSION SPLINT
|
Facility
|
OP
|
$48.91
|
|
|
Service Code
|
HCPCS S8450
|
| Hospital Charge Code |
41809370
|
|
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
|
|
|
OT STATIC PROG WRIST EXTENSION
|
Facility
|
OP
|
$195.62
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
41809270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.32
|
| Rate for Payer: Aetna Government |
$38.32
|
| Rate for Payer: Brighton Health Commercial |
$117.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.48
|
| Rate for Payer: EmblemHealth Commercial |
$97.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.40
|
| Rate for Payer: Group Health Inc Commercial |
$97.81
|
| Rate for Payer: Group Health Inc Medicare |
$68.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.15
|
|
