|
HC PT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 97763 GP
|
| Hospital Charge Code |
4209776301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.00
|
|
|
HC PT PARAFFIN BATH THERAPY
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
4209701801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
|
|
HC PT PARAFFIN BATH THERAPY
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
4209701801
|
|
Hospital Revenue Code
|
420
|
| 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 PT PHYSICAL PERFORMANCE TEST
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
4209775001
|
|
Hospital Revenue Code
|
420
|
| 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 PT PHYSICAL PERFORMANCE TEST
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
4209775001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
|
|
HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
4249716301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$124.50 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.50
|
|
|
HC PT PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
4249716301
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$470.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.11
|
| Rate for Payer: Aetna Government |
$49.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$470.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$470.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$209.33
|
| Rate for Payer: Amida Care Medicaid |
$209.33
|
| 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 |
$124.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$470.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$209.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$470.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$470.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.79
|
| Rate for Payer: Group Health Inc Commercial |
$124.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.33
|
| Rate for Payer: Healthfirst Essential Plan |
$470.99
|
| Rate for Payer: Healthfirst QHP |
$341.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.33
|
| Rate for Payer: SOMOS Essential |
$470.99
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$470.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$230.26
|
| Rate for Payer: United Healthcare Medicaid |
$209.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$209.33
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
4249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$124.50 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.50
|
|
|
HC PT PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
4249716101
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$282.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.11
|
| Rate for Payer: Aetna Government |
$49.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$282.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$282.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$125.60
|
| Rate for Payer: Amida Care Medicaid |
$125.60
|
| 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 |
$124.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$282.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$125.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$282.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.88
|
| Rate for Payer: Group Health Inc Commercial |
$124.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.60
|
| Rate for Payer: Healthfirst Essential Plan |
$282.59
|
| Rate for Payer: Healthfirst QHP |
$204.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.60
|
| Rate for Payer: SOMOS Essential |
$282.59
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$282.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$138.16
|
| Rate for Payer: United Healthcare Medicaid |
$125.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$125.60
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
4249716201
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$124.50 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.50
|
|
|
HC PT PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
4249716201
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$376.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.11
|
| Rate for Payer: Aetna Government |
$49.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$376.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$376.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$167.46
|
| Rate for Payer: Amida Care Medicaid |
$167.46
|
| 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 |
$124.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$376.79
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$167.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.83
|
| Rate for Payer: Group Health Inc Commercial |
$124.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.46
|
| Rate for Payer: Healthfirst Essential Plan |
$376.79
|
| Rate for Payer: Healthfirst QHP |
$272.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.46
|
| Rate for Payer: SOMOS Essential |
$376.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$376.79
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$184.21
|
| Rate for Payer: United Healthcare Medicaid |
$167.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$167.46
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
4249716401
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$33.56 |
| Max. Negotiated Rate |
$282.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.56
|
| Rate for Payer: Aetna Government |
$33.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$282.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$282.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$125.60
|
| Rate for Payer: Amida Care Medicaid |
$125.60
|
| 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 |
$85.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$282.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$125.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$282.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.88
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.60
|
| Rate for Payer: Healthfirst Essential Plan |
$282.59
|
| Rate for Payer: Healthfirst QHP |
$204.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.60
|
| Rate for Payer: SOMOS Essential |
$282.59
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$282.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$138.16
|
| Rate for Payer: United Healthcare Medicaid |
$125.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$125.60
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
4249716401
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC PT PREVENTIVE VISIT,NEW,40-64
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99386 GP
|
| Hospital Charge Code |
4219938601
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PT PREVENTIVE VISIT,NEW,40-64
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99386 GP
|
| Hospital Charge Code |
4219938601
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.17
|
| Rate for Payer: Aetna Government |
$114.17
|
| 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 |
$179.00
|
| Rate for Payer: Group Health Inc Commercial |
$179.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT PROSTHETIC TRAINING, EACH 15 MIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
4209776101
|
|
Hospital Revenue Code
|
420
|
| 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 PT PROSTHETIC TRAINING, EACH 15 MIN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
4209776101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.00
|
|
|
HC PT PROSTHETIC TRAINING-EXT. 15MTS
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 97520 GP
|
| Hospital Charge Code |
4209752001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.50
|
| Rate for Payer: Aetna Government |
$93.50
|
| 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 |
$93.50
|
| Rate for Payer: Group Health Inc Commercial |
$93.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT PROSTHETIC TRAINING-EXT. 15MTS
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 97520 GP
|
| Hospital Charge Code |
4209752001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.50
|
|
|
HC PT RANGE MOTION MEASURE,EACH EXTREM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 95851 GP
|
| Hospital Charge Code |
4209585101
|
|
Hospital Revenue Code
|
420
|
| 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 PT RANGE MOTION MEASURE,EACH EXTREM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 95851 GP
|
| Hospital Charge Code |
4209585101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC PT RANGE OG MOTION, HAND, W OR W/O COMP
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 95852 GP
|
| Hospital Charge Code |
4209585201
|
|
Hospital Revenue Code
|
420
|
| 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 PT RANGE OG MOTION, HAND, W OR W/O COMP
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 95852 GP
|
| Hospital Charge Code |
4209585201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
|
|
HC PT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
4209753501
|
|
Hospital Revenue Code
|
420
|
| 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 PT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
4209753501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.50
|
|
