|
HC PT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GP
|
| Hospital Charge Code |
4209753301
|
|
Hospital Revenue Code
|
420
|
| 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 PT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GP
|
| Hospital Charge Code |
4209753301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.50
|
|
|
HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
4209753001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.00
|
|
|
HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
4209753001
|
|
Hospital Revenue Code
|
420
|
| 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 PT THERAPEUTIC EXERCISES
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
4209711001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.50
|
|
|
HC PT THERAPEUTIC EXERCISES
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
4209711001
|
|
Hospital Revenue Code
|
420
|
| 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 PT ULTRASOUND THERAPY
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
4209703501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC PT ULTRASOUND THERAPY
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
4209703501
|
|
Hospital Revenue Code
|
420
|
| 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 PT UNLISTED MODALITY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 97039 GP
|
| Hospital Charge Code |
4209703901
|
|
Hospital Revenue Code
|
420
|
| 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 PT UNLISTED MODALITY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 97039 GP
|
| Hospital Charge Code |
4209703901
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC PT UNLISTED PT PROCEDURE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 97799 GP
|
| Hospital Charge Code |
4209779901
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
|
|
HC PT UNLISTED PT PROCEDURE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 97799 GP
|
| Hospital Charge Code |
4209779901
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.91 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.00
|
| Rate for Payer: Aetna Government |
$35.00
|
| 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 |
$35.00
|
| 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 |
$35.00
|
| 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 UNLISTED THER.PROCEDURE 15MIN
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 97139 GP
|
| Hospital Charge Code |
4209713901
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.50
|
|
|
HC PT UNLISTED THER.PROCEDURE 15MIN
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 97139 GP
|
| Hospital Charge Code |
4209713901
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.91
|
| Rate for Payer: Aetna Government |
$14.91
|
| 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 |
$15.50
|
| 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 |
$15.50
|
| 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 VASOPNEUMATIC DEVICE THERAPY
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 97016 GP
|
| Hospital Charge Code |
4209701601
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.69
|
| Rate for Payer: Aetna Government |
$11.69
|
| 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 |
$17.50
|
| 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 |
$17.50
|
| 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 VASOPNEUMATIC DEVICE THERAPY
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 97016 GP
|
| Hospital Charge Code |
4209701601
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
4209754201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.00
|
|
|
HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
4209754201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.52
|
| Rate for Payer: Aetna Government |
$18.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$135.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$135.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.24
|
| Rate for Payer: Amida Care Medicaid |
$60.24
|
| 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 |
$48.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$135.54
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$60.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.25
|
| Rate for Payer: Group Health Inc Commercial |
$48.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.24
|
| Rate for Payer: Healthfirst Essential Plan |
$135.54
|
| Rate for Payer: Healthfirst QHP |
$98.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.24
|
| Rate for Payer: SOMOS Essential |
$135.54
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$135.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$66.26
|
| Rate for Payer: United Healthcare Medicaid |
$60.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$60.24
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT WHIRLPOOL THERAPY
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
4209702201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.50
|
|
|
HC PT WHIRLPOOL THERAPY
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
4209702201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.37
|
| Rate for Payer: Aetna Government |
$14.37
|
| 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 |
$26.50
|
| 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 |
$26.50
|
| 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 WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
4209760201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC PT WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
4209760201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.66 |
| Max. Negotiated Rate |
$290.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.66
|
| Rate for Payer: Aetna Government |
$32.66
|
| 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 PULM FUNCTION TEST BY GAS - HELIUM DILUTION LUNG VOLUMES
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
4609472701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC PULM FUNCTION TEST BY GAS - HELIUM DILUTION LUNG VOLUMES
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
4609472701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC PULM FUNCT TST PLETHYSMOGRAP - BODY PLETHYSMOGRAPHIC LUNG VOLUMES
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
4609472602
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
