Contract Rates for Outpatient Covered Services. The Contract Rate for the provision of the Covered Services set forth in Table 2 of this Appendix rendered by Facility to a Customer on an outpatient basis (not during an Admission), will be as set forth in Table 2 of this Appendix. Facility is required to identify each date of service when submitting claims for Outpatient Covered Services spanning multiple dates of service. If more than one type of Service Category is provided to a Customer on an outpatient basis during one calendar day, United or Payer will pay facility for each Service Category. Table 2: Outpatient Covered Services Category Table SERVICE CATEGORY SERVICE CATEGORY DEFINITION PAYMENT METHOD CONTRACT RATE Physical Therapy Revenue Codes 0420, 0421, 0422, 0423, 0424, 0429 Per Visit $ 65.00 Occupational Therapy Revenue Codes 0430, 0431, 0432, 0433, 0434, 0439 Per Visit $ 65.00 Speech Therapy Revenue Codes 0440, 0441, 0442, 0443, 0444, 0449 Per Visit $ 65.00