|
HC OT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
4309776301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.80
|
| 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 |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$78.00
|
| Rate for Payer: Group Health Inc Commercial |
$78.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 97763 GO
|
| Hospital Charge Code |
4309776301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.00
|
|
|
HC OT PARAFFIN BATH THERAPY
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
4309701801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.85
|
| Rate for Payer: Aetna Government |
$6.85
|
| 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 |
$9.00
|
| 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 |
$9.00
|
| 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 PARAFFIN BATH THERAPY
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
4309701801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
|
|
HC OT PHYSICAL PERFORMANCE TEST
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
4309775001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$222.00 |
| 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 |
$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 PHYSICAL PERFORMANCE TEST
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
4309775001
|
|
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 PROSTHETIC TRAINING, EACH 15 MIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 97761 GO
|
| Hospital Charge Code |
4309776101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.85
|
| Rate for Payer: Aetna Government |
$19.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$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 |
$61.00
|
| 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 |
$61.00
|
| 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 PROSTHETIC TRAINING, EACH 15 MIN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 97761 GO
|
| Hospital Charge Code |
4309776101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.00
|
|
|
HC OT RANGE MOTION MEASURE,EACH EXTREM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 95851 GO
|
| Hospital Charge Code |
4309585101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC OT RANGE MOTION MEASURE,EACH EXTREM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 95851 GO
|
| Hospital Charge Code |
4309585101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| 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 |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$11.50
|
| Rate for Payer: Group Health Inc Commercial |
$11.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT RANGE OG MOTION, HAND, W OR W/O COMP
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 95852 GO
|
| Hospital Charge Code |
4309585201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| 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 |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT RANGE OG MOTION, HAND, W OR W/O COMP
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 95852 GO
|
| Hospital Charge Code |
4309585201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
|
|
HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
4309753501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.50
|
|
|
HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
4309753501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.18
|
| Rate for Payer: Aetna Government |
$21.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$125.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$125.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.87
|
| Rate for Payer: Amida Care Medicaid |
$55.87
|
| 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 |
$49.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$125.70
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$55.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.66
|
| Rate for Payer: Group Health Inc Commercial |
$49.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.87
|
| Rate for Payer: Healthfirst Essential Plan |
$125.70
|
| Rate for Payer: Healthfirst QHP |
$91.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: SOMOS Essential |
$125.70
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$125.70
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61.45
|
| Rate for Payer: United Healthcare Medicaid |
$55.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$55.87
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
4309753301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.32
|
| Rate for Payer: Aetna Government |
$17.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$125.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$125.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.87
|
| Rate for Payer: Amida Care Medicaid |
$55.87
|
| 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 |
$76.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$125.70
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$55.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.66
|
| Rate for Payer: Group Health Inc Commercial |
$76.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.87
|
| Rate for Payer: Healthfirst Essential Plan |
$125.70
|
| Rate for Payer: Healthfirst QHP |
$91.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: SOMOS Essential |
$125.70
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$125.70
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61.45
|
| Rate for Payer: United Healthcare Medicaid |
$55.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$55.87
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC OT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
4309753301
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.50
|
|
|
HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
4309753001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.00
|
|
|
HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
4309753001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.87
|
| Rate for Payer: Aetna Government |
$20.87
|
| 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 |
$58.00
|
| 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 |
$58.00
|
| 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 THERAPEUTIC EXERCISES
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
4309711001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.41
|
| Rate for Payer: Aetna Government |
$19.41
|
| 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 |
$44.50
|
| 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 |
$44.50
|
| 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 THERAPEUTIC EXERCISES
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
4309711001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.50
|
|
|
HC OT ULTRASOUND THERAPY
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
4309703501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC OT ULTRASOUND THERAPY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
4309703501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.63
|
| Rate for Payer: Aetna Government |
$7.63
|
| 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 |
$21.00
|
| 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 |
$21.00
|
| 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 UNLISTED MODALITY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 97039 GO
|
| Hospital Charge Code |
4309703901
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.02
|
| Rate for Payer: Aetna Government |
$11.02
|
| 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 UNLISTED MODALITY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 97039 GO
|
| Hospital Charge Code |
4309703901
|
|
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 UNLISTED OT PROCEDURE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 97799 GO
|
| Hospital Charge Code |
4309779901
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
|
