|
PT MANUAL THERAY TECHNIQUES 15MTS
|
Facility
|
OP
|
$81.83
|
|
|
Service Code
|
HCPCS 97140 GP
|
| Hospital Charge Code |
41701125
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PT MASSAGE 15 MTS
|
Facility
|
OP
|
$85.48
|
|
|
Service Code
|
HCPCS 97124 GP
|
| Hospital Charge Code |
41701123
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM BIOFEEDBACK TRAIN. BY ANY MOD
|
Facility
|
OP
|
$57.33
|
|
|
Service Code
|
HCPCS 90901 GP
|
| Hospital Charge Code |
41702145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.30
|
| Rate for Payer: Aetna Government |
$96.30
|
| 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 |
$28.66
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.66
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PTM CANES (FIXED)
|
Facility
|
OP
|
$52.09
|
|
|
Service Code
|
HCPCS E0100
|
| Hospital Charge Code |
41702402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.34
|
| Rate for Payer: Aetna Government |
$17.34
|
| Rate for Payer: Brighton Health Commercial |
$39.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.42
|
| Rate for Payer: Group Health Inc Commercial |
$26.04
|
| Rate for Payer: Group Health Inc Medicare |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.04
|
|
|
PTM - CONTRAST BATH 15 MTS
|
Facility
|
OP
|
$44.20
|
|
|
Service Code
|
HCPCS 97034 GP
|
| Hospital Charge Code |
41702115
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.95
|
| Rate for Payer: Aetna Government |
$10.95
|
| 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 |
$22.10
|
| 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 |
$22.10
|
| 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
|
|
|
PTM CRUTCHES (PAIR)
|
Facility
|
OP
|
$81.51
|
|
|
Service Code
|
HCPCS E0114
|
| Hospital Charge Code |
41702401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$65.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.17
|
| Rate for Payer: Aetna Government |
$36.17
|
| Rate for Payer: Brighton Health Commercial |
$61.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.43
|
| Rate for Payer: Group Health Inc Commercial |
$40.76
|
| Rate for Payer: Group Health Inc Medicare |
$28.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
|
|
PTM DIATHERMY
|
Facility
|
OP
|
$21.33
|
|
|
Service Code
|
HCPCS 97024 GP
|
| Hospital Charge Code |
41702110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.97
|
| Rate for Payer: Aetna Government |
$3.97
|
| 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 |
$10.66
|
| 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 |
$10.66
|
| 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
|
|
|
PTM E-STIM (MANUAL-ATTEND) 15 MTS
|
Facility
|
OP
|
$42.63
|
|
|
Service Code
|
HCPCS 97032 GP
|
| Hospital Charge Code |
41702113
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM E-STIM (UNATTENDED)
|
Facility
|
OP
|
$32.60
|
|
|
Service Code
|
HCPCS 97014 GP
|
| Hospital Charge Code |
41702105
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM FUNCTIONAL PERFORMANCE 15 MTS
|
Facility
|
OP
|
$116.13
|
|
|
Service Code
|
HCPCS 97530 GP
|
| Hospital Charge Code |
41702129
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM GAIT TRAINING 15 MTS
|
Facility
|
OP
|
$88.03
|
|
|
Service Code
|
HCPCS 97116 GP
|
| Hospital Charge Code |
41702122
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.96
|
| Rate for Payer: Aetna Government |
$16.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.88
|
| Rate for Payer: Amida Care Medicaid |
$47.88
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,788.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.27
|
| Rate for Payer: Group Health Inc Commercial |
$44.02
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Healthfirst Essential Plan |
$107.73
|
| Rate for Payer: Healthfirst QHP |
$47.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.88
|
| Rate for Payer: SOMOS Essential |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$107.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52.67
|
| Rate for Payer: United Healthcare Medicaid |
$47.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PTM HOT/COLD PACKS
|
Facility
|
OP
|
$36.86
|
|
|
Service Code
|
HCPCS 97010 GP
|
| Hospital Charge Code |
41702103
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM HUBBARD TANK 15 MTS
|
Facility
|
OP
|
$104.63
|
|
|
Service Code
|
HCPCS 97036 GP
|
| Hospital Charge Code |
41702117
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$2,902.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.11
|
| Rate for Payer: Aetna Government |
$20.11
|
| 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 |
$52.32
|
| 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 |
$52.32
|
| 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
|
|
|
PTM IONTOPHORESIS 15 MTS
|
Facility
|
OP
|
$60.78
|
|
|
Service Code
|
HCPCS 97033 GP
|
| Hospital Charge Code |
41702114
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM MANUAL THRPY TECHNIQUES 15MTS
|
Facility
|
OP
|
$81.83
|
|
|
Service Code
|
HCPCS 97140 GP
|
| Hospital Charge Code |
41702125
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM MASSAGE 15 MTS
|
Facility
|
OP
|
$85.48
|
|
|
Service Code
|
HCPCS 97124 GP
|
| Hospital Charge Code |
41702123
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM NEUROMUSCULAR REEDUCAT. 15MTS
|
Facility
|
OP
|
$102.45
|
|
|
Service Code
|
HCPCS 97112 GP
|
| Hospital Charge Code |
41702120
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM ORTHOTIC F/T-EXTREMITIES 15MT
|
Facility
|
OP
|
$145.48
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
41702127
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM ORTHOTIC PROSTH. CKOUT 15 MTS
|
Facility
|
OP
|
$156.48
|
|
|
Service Code
|
HCPCS 97763
|
| Hospital Charge Code |
41702135
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM PARAFFIN BATH
|
Facility
|
OP
|
$18.10
|
|
|
Service Code
|
HCPCS 97018 GP
|
| Hospital Charge Code |
41702107
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM PHYSICAL PERFORM. TEST 15 MTS
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 97750 GP
|
| Hospital Charge Code |
41702136
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM PROSTHETIC TRAINING-EXT. 15MT
|
Facility
|
OP
|
$122.90
|
|
|
Service Code
|
HCPCS 97761
|
| Hospital Charge Code |
41702128
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM RE-EVALUATION
|
Facility
|
OP
|
$171.98
|
|
|
Service Code
|
HCPCS 97164 GP
|
| Hospital Charge Code |
41702102
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$33.56 |
| Max. Negotiated Rate |
$11,418.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.56
|
| Rate for Payer: Aetna Government |
$33.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$256.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$256.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$114.18
|
| Rate for Payer: Amida Care Medicaid |
$114.18
|
| 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: Fidelis CHP/HARP/Medicaid |
$11,418.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.89
|
| Rate for Payer: Group Health Inc Commercial |
$85.99
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.18
|
| Rate for Payer: Healthfirst Essential Plan |
$256.90
|
| Rate for Payer: Healthfirst QHP |
$114.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.18
|
| Rate for Payer: SOMOS Essential |
$256.90
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$256.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$125.60
|
| Rate for Payer: United Healthcare Medicaid |
$114.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$114.18
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
PTM ROM - EACH EXTREMITY/TRUNK
|
Facility
|
OP
|
$23.33
|
|
|
Service Code
|
HCPCS 95851 GP
|
| Hospital Charge Code |
41702139
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PTM ROM - HAND
|
Facility
|
OP
|
$17.48
|
|
|
Service Code
|
HCPCS 95852 GP
|
| Hospital Charge Code |
41702140
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
