|
OT STOCKNETTE (YARD)
|
Facility
|
OP
|
$32.60
|
|
|
Service Code
|
HCPCS Q4051
|
| Hospital Charge Code |
41808085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.30
|
| Rate for Payer: Aetna Government |
$16.30
|
| Rate for Payer: Brighton Health Commercial |
$24.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.17
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$11.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
|
|
OT SUPER GRIP UTENSILS
|
Facility
|
OP
|
$17.01
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809524
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.57
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
OT TAPE
|
Facility
|
OP
|
$117.60
|
|
|
Service Code
|
HCPCS A4452
|
| Hospital Charge Code |
41809452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$88.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.97
|
| Rate for Payer: Group Health Inc Commercial |
$58.80
|
| Rate for Payer: Group Health Inc Medicare |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.80
|
|
|
OT THERABALL
|
Facility
|
OP
|
$7.09
|
|
|
Service Code
|
HCPCS A9300
|
| Hospital Charge Code |
41809465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.85
|
| Rate for Payer: Aetna Government |
$7.85
|
| 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 THERP.PROCE., GROUP (2 OR MORE
|
Facility
|
OP
|
$52.88
|
|
|
Service Code
|
HCPCS 97150 GO
|
| Hospital Charge Code |
41809495
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.34
|
| Rate for Payer: Aetna Government |
$10.34
|
| 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 |
$26.44
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT THERP.PROCE-ONE/MORE AREAS 15M
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
HCPCS 97110 GO
|
| Hospital Charge Code |
41809484
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.41
|
| Rate for Payer: Aetna Government |
$19.41
|
| 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 |
$44.55
|
| 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 |
$44.55
|
| 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 THUMB SPICA
|
Facility
|
OP
|
$978.08
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
41808070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.97 |
| Max. Negotiated Rate |
$1,026.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$537.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.97
|
| Rate for Payer: Aetna Government |
$188.97
|
| Rate for Payer: Brighton Health Commercial |
$586.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$489.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$562.40
|
| Rate for Payer: EmblemHealth Commercial |
$489.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,026.98
|
| Rate for Payer: Group Health Inc Commercial |
$489.04
|
| Rate for Payer: Group Health Inc Medicare |
$342.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$489.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$635.75
|
|
|
OT THUMB SPICA -FOREARM
|
Facility
|
OP
|
$211.92
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
41809230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.17 |
| Max. Negotiated Rate |
$222.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.97
|
| Rate for Payer: Aetna Government |
$188.97
|
| Rate for Payer: Brighton Health Commercial |
$127.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.85
|
| Rate for Payer: EmblemHealth Commercial |
$105.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.52
|
| Rate for Payer: Group Health Inc Commercial |
$105.96
|
| Rate for Payer: Group Health Inc Medicare |
$74.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.75
|
|
|
OT THUMB SPICA -HAND BASED
|
Facility
|
OP
|
$97.81
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
41809240
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.23 |
| Max. Negotiated Rate |
$188.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.97
|
| Rate for Payer: Aetna Government |
$188.97
|
| Rate for Payer: Brighton Health Commercial |
$58.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.24
|
| Rate for Payer: EmblemHealth Commercial |
$48.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.70
|
| Rate for Payer: Group Health Inc Commercial |
$48.90
|
| Rate for Payer: Group Health Inc Medicare |
$34.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.58
|
|
|
OT TUBULAR DRESSING W/ OR W/O E
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS A6457
|
| Hospital Charge Code |
41809576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
|
|
OT ULISTED THERP.PROCEDURE 15 MTS
|
Facility
|
OP
|
$31.19
|
|
|
Service Code
|
HCPCS 97139 GO
|
| Hospital Charge Code |
41809493
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.91
|
| Rate for Payer: Aetna Government |
$14.91
|
| 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 |
$15.60
|
| 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 |
$15.60
|
| 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 ULNAR GUTTER
|
Facility
|
OP
|
$244.52
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
41806200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.58 |
| Max. Negotiated Rate |
$256.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.89
|
| Rate for Payer: Aetna Government |
$195.89
|
| Rate for Payer: Brighton Health Commercial |
$146.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.60
|
| Rate for Payer: EmblemHealth Commercial |
$122.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$256.75
|
| Rate for Payer: Group Health Inc Commercial |
$122.26
|
| Rate for Payer: Group Health Inc Medicare |
$85.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.94
|
|
|
OT ULTRASOUND 15MTS
|
Facility
|
OP
|
$42.05
|
|
|
Service Code
|
HCPCS 97035 GO
|
| Hospital Charge Code |
41809481
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.63
|
| Rate for Payer: Aetna Government |
$7.63
|
| 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 |
$21.02
|
| 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 |
$21.02
|
| 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 UNLISTED MODALITY
|
Facility
|
OP
|
$36.86
|
|
|
Service Code
|
HCPCS 97039 GO
|
| Hospital Charge Code |
41809483
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.02
|
| Rate for Payer: Aetna Government |
$11.02
|
| 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
|
|
|
OT UNLISTED OT PROCEDURE
|
Facility
|
OP
|
$70.88
|
|
|
Service Code
|
HCPCS 97799 GO
|
| Hospital Charge Code |
41809507
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.44
|
| Rate for Payer: Aetna Government |
$35.44
|
| 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 |
$35.44
|
| 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 |
$35.44
|
| 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 UTENSIL HOLDER
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.75
|
| Rate for Payer: Group Health Inc Commercial |
$4.96
|
| Rate for Payer: Group Health Inc Medicare |
$3.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.96
|
|
|
OT VASOPNEUMATIC DEVICE
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 97016 GO
|
| Hospital Charge Code |
41809471
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.69
|
| Rate for Payer: Aetna Government |
$11.69
|
| 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 |
$17.99
|
| 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 |
$17.99
|
| 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 VOACTIONAL REHAB 15 MTS
|
Facility
|
OP
|
$95.18
|
|
|
Service Code
|
HCPCS 97537 GO
|
| Hospital Charge Code |
41809500
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$5,078.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.08
|
| Rate for Payer: Aetna Government |
$18.08
|
| 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 |
$47.59
|
| 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 |
$47.59
|
| 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 W/C BASKET
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
41809543
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.00
|
| Rate for Payer: Aetna Government |
$27.00
|
| 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 |
$27.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT WEIGHTED UTENSILS
|
Facility
|
OP
|
$17.01
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
41809523
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.57
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
OT WHEEL CHAIR TRAINING 15 MTS
|
Facility
|
OP
|
$96.25
|
|
|
Service Code
|
HCPCS 97542 GO
|
| Hospital Charge Code |
41809536
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$5,477.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.52
|
| Rate for Payer: Aetna Government |
$18.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$123.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$123.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$54.77
|
| Rate for Payer: Amida Care Medicaid |
$54.77
|
| 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 |
$5,477.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.51
|
| Rate for Payer: Group Health Inc Commercial |
$48.12
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.77
|
| Rate for Payer: Healthfirst Essential Plan |
$123.23
|
| Rate for Payer: Healthfirst QHP |
$54.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.77
|
| Rate for Payer: SOMOS Essential |
$123.23
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$123.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$60.25
|
| Rate for Payer: United Healthcare Medicaid |
$54.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$54.77
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT WHEEL CHAIR TRAINING 15MTS
|
Facility
|
OP
|
$96.25
|
|
|
Service Code
|
HCPCS 97542 GO
|
| Hospital Charge Code |
41809501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$5,477.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.52
|
| Rate for Payer: Aetna Government |
$18.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$123.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$123.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$54.77
|
| Rate for Payer: Amida Care Medicaid |
$54.77
|
| 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 |
$5,477.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.51
|
| Rate for Payer: Group Health Inc Commercial |
$48.12
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.77
|
| Rate for Payer: Healthfirst Essential Plan |
$123.23
|
| Rate for Payer: Healthfirst QHP |
$54.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.77
|
| Rate for Payer: SOMOS Essential |
$123.23
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$123.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$60.25
|
| Rate for Payer: United Healthcare Medicaid |
$54.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$54.77
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
OT WHIRLPOOL
|
Facility
|
OP
|
$53.30
|
|
|
Service Code
|
HCPCS 97022 GO
|
| Hospital Charge Code |
41809474
|
|
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 WOUND CARE-NONSELCTVE DEBRDMNT
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
41809518
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
OT WOUND CARE-NONSELCTVE DEBRDMNT
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
41809518
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
