|
HC OT GROUP THERAPEUTIC PROCEDURES
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 97150 GO
|
| Hospital Charge Code |
4309715001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC OT HOT OR COLD PACKS THERAPY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 97010 GO
|
| Hospital Charge Code |
4309701001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.75
|
| Rate for Payer: Aetna Government |
$3.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$18.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| Rate for Payer: Group Health Inc Commercial |
$18.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT HOT OR COLD PACKS THERAPY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 97010 GO
|
| Hospital Charge Code |
4309701001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC OT HYDROTHERAPY
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 97036 GO
|
| Hospital Charge Code |
4309703601
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.11
|
| Rate for Payer: Aetna Government |
$20.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| Rate for Payer: Group Health Inc Commercial |
$52.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT HYDROTHERAPY
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 97036 GO
|
| Hospital Charge Code |
4309703601
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
|
|
HC OT MANUAL THER TECH,1+REGIONS,EA 15 MIN
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
4309714001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.50
|
|
|
HC OT MANUAL THER TECH,1+REGIONS,EA 15 MIN
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
4309714001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.78
|
| Rate for Payer: Aetna Government |
$17.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$118.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$118.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.67
|
| Rate for Payer: Amida Care Medicaid |
$52.67
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$40.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$118.52
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$52.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.31
|
| Rate for Payer: Group Health Inc Commercial |
$40.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Healthfirst Essential Plan |
$118.52
|
| Rate for Payer: Healthfirst QHP |
$85.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: SOMOS Essential |
$118.52
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$118.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$57.94
|
| Rate for Payer: United Healthcare Medicaid |
$52.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT MASSAGE THERAPY
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
4309712401
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.74
|
| Rate for Payer: Aetna Government |
$15.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$118.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$118.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.67
|
| Rate for Payer: Amida Care Medicaid |
$52.67
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$42.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$118.52
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$52.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.31
|
| Rate for Payer: Group Health Inc Commercial |
$42.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Healthfirst Essential Plan |
$118.52
|
| Rate for Payer: Healthfirst QHP |
$85.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: SOMOS Essential |
$118.52
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$118.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$57.94
|
| Rate for Payer: United Healthcare Medicaid |
$52.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT MASSAGE THERAPY
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
4309712401
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
|
|
HC OT NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97605 GO
|
| Hospital Charge Code |
4309760501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC OT NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97605 GO
|
| Hospital Charge Code |
4309760501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$290.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.46
|
| Rate for Payer: Aetna Government |
$35.46
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$264.50
|
| Rate for Payer: Group Health Inc Commercial |
$264.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 97606 GO
|
| Hospital Charge Code |
4309760601
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC OT NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 97606 GO
|
| Hospital Charge Code |
4309760601
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$531.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$531.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.97
|
| Rate for Payer: Aetna Government |
$41.97
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$483.50
|
| Rate for Payer: Group Health Inc Commercial |
$483.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
4309711201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.29
|
| Rate for Payer: Aetna Government |
$20.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$118.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$118.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.67
|
| Rate for Payer: Amida Care Medicaid |
$52.67
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$51.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$118.52
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$52.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.31
|
| 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 |
$52.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Healthfirst Essential Plan |
$118.52
|
| Rate for Payer: Healthfirst QHP |
$85.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: SOMOS Essential |
$118.52
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$118.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$57.94
|
| Rate for Payer: United Healthcare Medicaid |
$52.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
4309711201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
4349716701
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.00
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
4349716701
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$423.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$145.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.55
|
| Rate for Payer: Aetna Government |
$47.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$423.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$423.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$188.41
|
| Rate for Payer: Amida Care Medicaid |
$188.41
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$132.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$423.92
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$188.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$423.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.83
|
| Rate for Payer: Group Health Inc Commercial |
$132.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.41
|
| Rate for Payer: Healthfirst Essential Plan |
$423.92
|
| Rate for Payer: Healthfirst QHP |
$307.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.41
|
| Rate for Payer: SOMOS Essential |
$423.92
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$423.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$207.25
|
| Rate for Payer: United Healthcare Medicaid |
$188.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$188.41
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
4349716501
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$254.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$145.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.55
|
| Rate for Payer: Aetna Government |
$47.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$113.05
|
| Rate for Payer: Amida Care Medicaid |
$113.05
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$132.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$254.37
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$113.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.71
|
| Rate for Payer: Group Health Inc Commercial |
$132.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.05
|
| Rate for Payer: Healthfirst Essential Plan |
$254.37
|
| Rate for Payer: Healthfirst QHP |
$184.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.05
|
| Rate for Payer: SOMOS Essential |
$254.37
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$254.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$124.36
|
| Rate for Payer: United Healthcare Medicaid |
$113.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$113.05
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
4349716501
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$132.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.50
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
4349716601
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$339.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$145.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.55
|
| Rate for Payer: Aetna Government |
$47.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$339.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$339.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$150.73
|
| Rate for Payer: Amida Care Medicaid |
$150.73
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$132.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$339.14
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$150.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$339.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.27
|
| Rate for Payer: Group Health Inc Commercial |
$132.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.73
|
| Rate for Payer: Healthfirst Essential Plan |
$339.14
|
| Rate for Payer: Healthfirst QHP |
$245.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.73
|
| Rate for Payer: SOMOS Essential |
$339.14
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$339.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$165.80
|
| Rate for Payer: United Healthcare Medicaid |
$150.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$150.73
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
4349716601
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.00
|
|
|
HC OT OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
4349716801
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC OT OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
4349716801
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$254.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.45
|
| Rate for Payer: Aetna Government |
$31.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$113.05
|
| Rate for Payer: Amida Care Medicaid |
$113.05
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$91.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$254.37
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$113.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.71
|
| Rate for Payer: Group Health Inc Commercial |
$91.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.05
|
| Rate for Payer: Healthfirst Essential Plan |
$254.37
|
| Rate for Payer: Healthfirst QHP |
$184.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.05
|
| Rate for Payer: SOMOS Essential |
$254.37
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$254.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$124.36
|
| Rate for Payer: United Healthcare Medicaid |
$113.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$113.05
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
4309776001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.95
|
| Rate for Payer: Aetna Government |
$22.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$118.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$118.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.67
|
| Rate for Payer: Amida Care Medicaid |
$52.67
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$72.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$118.52
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$52.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.31
|
| Rate for Payer: Group Health Inc Commercial |
$72.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Healthfirst Essential Plan |
$118.52
|
| Rate for Payer: Healthfirst QHP |
$85.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.67
|
| Rate for Payer: SOMOS Essential |
$118.52
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$118.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$57.94
|
| Rate for Payer: United Healthcare Medicaid |
$52.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.67
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 97760 GO
|
| Hospital Charge Code |
4309776001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
|
