|
PSS W 1-3 PARAMETERS
|
Facility
|
IP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95808 TC
|
| Hospital Charge Code |
40401603
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$1,209.08
|
|
|
PSS W 1-3 PARAMETERS
|
Facility
|
OP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95808 TC
|
| Hospital Charge Code |
40401603
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$822.00 |
| Max. Negotiated Rate |
$2,202.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,514.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,209.08
|
| Rate for Payer: Aetna Government |
$1,209.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$846.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$846.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$846.36
|
| Rate for Payer: Brighton Health Commercial |
$2,064.74
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,209.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,202.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,872.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,209.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,209.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,209.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.08
|
| Rate for Payer: Group Health Inc Commercial |
$1,209.08
|
| Rate for Payer: Group Health Inc Medicare |
$1,209.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,027.72
|
| Rate for Payer: Healthfirst QHP |
$1,209.08
|
| Rate for Payer: Humana Medicare |
$1,233.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,209.08
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,209.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,209.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$967.26
|
| Rate for Payer: Wellcare Medicare |
$1,148.63
|
|
|
PSSW4/> PARAM W TECH
|
Facility
|
IP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95810 TC
|
| Hospital Charge Code |
40401604
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$1,209.08
|
|
|
PSSW4/> PARAM W TECH
|
Facility
|
OP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95810 TC
|
| Hospital Charge Code |
40401604
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$822.00 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,514.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,209.08
|
| Rate for Payer: Aetna Government |
$1,209.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$846.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$846.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$846.36
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,209.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,202.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,872.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,209.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,209.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,209.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.08
|
| Rate for Payer: Group Health Inc Commercial |
$1,209.08
|
| Rate for Payer: Group Health Inc Medicare |
$1,209.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,027.72
|
| Rate for Payer: Healthfirst QHP |
$1,209.08
|
| Rate for Payer: Humana Medicare |
$1,233.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,209.08
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,209.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,209.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$967.26
|
| Rate for Payer: Wellcare Medicare |
$1,148.63
|
|
|
PSS W 4/> P W CPAP/BIPAP
|
Facility
|
OP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95811 TC
|
| Hospital Charge Code |
40401605
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$822.00 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,514.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,209.08
|
| Rate for Payer: Aetna Government |
$1,209.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$846.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$846.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$846.36
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,209.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,202.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,872.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,209.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,209.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,209.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.08
|
| Rate for Payer: Group Health Inc Commercial |
$1,209.08
|
| Rate for Payer: Group Health Inc Medicare |
$1,209.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,027.72
|
| Rate for Payer: Healthfirst QHP |
$1,209.08
|
| Rate for Payer: Humana Medicare |
$1,233.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,209.08
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,209.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,209.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$967.26
|
| Rate for Payer: Wellcare Medicare |
$1,148.63
|
|
|
PSS W 4/> P W CPAP/BIPAP
|
Facility
|
IP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95811 TC
|
| Hospital Charge Code |
40401605
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$1,209.08
|
|
|
PS TIBIAL BEARING INSERT
|
Facility
|
IP
|
$3,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,935.00 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,935.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,935.00
|
|
|
PS TIBIAL BEARING INSERT
|
Facility
|
OP
|
$3,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,063.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,128.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,322.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,935.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,225.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,935.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,063.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,935.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,354.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,935.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,935.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,515.50
|
|
|
PS TIBIAL BEARING INSERT #6
|
Facility
|
OP
|
$3,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40201294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,183.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,191.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,390.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,290.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,992.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,183.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,394.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,589.60
|
|
|
PS TIBIAL BEARING INSERT #6
|
Facility
|
IP
|
$3,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40201294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,992.00 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,992.00
|
|
|
PSYCH DIAG EVAL
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
30305734
|
|
Hospital Revenue Code
|
900
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PSYCH DIAG EVAL
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
30305734
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Commercial |
$198.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
PSYCH DIAG EVAL W/MED SERVICES
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
30305735
|
|
Hospital Revenue Code
|
900
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PSYCH DIAG EVAL W/MED SERVICES
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
30305735
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Commercial |
$198.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
PSYCHIATRIC SERVICE/THERAPY
|
Facility
|
IP
|
$82.75
|
|
|
Service Code
|
HCPCS 90899
|
| Hospital Charge Code |
30305382
|
|
Hospital Revenue Code
|
919
|
| Rate for Payer: Cash Price |
$33.18
|
|
|
PSYCHIATRIC SERVICE/THERAPY
|
Facility
|
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 90899
|
| Hospital Charge Code |
30305382
|
|
Hospital Revenue Code
|
919
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.23
|
| Rate for Payer: Brighton Health Commercial |
$62.06
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: EmblemHealth Commercial |
$33.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| Rate for Payer: Group Health Inc Commercial |
$33.18
|
| Rate for Payer: Group Health Inc Medicare |
$33.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Humana Medicare |
$33.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$27,173.60
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$27,173.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,859.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,276.22
|
| Rate for Payer: Aetna Government |
$26,276.22
|
| Rate for Payer: Brighton Health Commercial |
$19,812.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,801.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,596.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,472.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,962.41
|
| Rate for Payer: EmblemHealth Commercial |
$905.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,276.22
|
| Rate for Payer: Group Health Inc Commercial |
$26,276.22
|
| Rate for Payer: Group Health Inc Medicare |
$26,276.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,276.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,218.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,276.22
|
| Rate for Payer: United Healthcare Commercial |
$27,173.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,276.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,276.22
|
| Rate for Payer: Wellcare Medicare |
$24,962.41
|
|
|
PSYCHOTHERAPY, 45 MIN PT&/FAMILY
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30310001
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PSYCHOTHERAPY, 45 MIN PT&/FAMILY
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30310001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
PSYCHOTHERAPY, 60 MIN PT/FAM E&M
|
Facility
|
OP
|
$296.35
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
30105106
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$12,188.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.81
|
| Rate for Payer: Aetna Government |
$153.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$274.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$121.88
|
| Rate for Payer: Amida Care Medicaid |
$121.88
|
| Rate for Payer: Brighton Health Commercial |
$222.26
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$122.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$237.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12,188.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.97
|
| Rate for Payer: Group Health Inc Commercial |
$148.18
|
| Rate for Payer: Group Health Inc Medicare |
$103.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.88
|
| Rate for Payer: Healthfirst Essential Plan |
$274.23
|
| Rate for Payer: Healthfirst QHP |
$121.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$276.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.73
|
| Rate for Payer: Optum Medicaid |
$122.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.88
|
| Rate for Payer: SOMOS Essential |
$274.23
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$274.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$134.07
|
| Rate for Payer: United Healthcare Medicaid |
$121.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$121.88
|
|
|
PSYCHOTHERAPY 60 MIN, PT & FAMILY
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
30105105
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PSYCHOTHERAPY 60 MIN, PT & FAMILY
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
30105105
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
PSYCHOTHERAPY FOR CRISIS- ADD 30
|
Facility
|
OP
|
$266.25
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
30105104
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.21 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.21
|
| Rate for Payer: Aetna Government |
$78.21
|
| Rate for Payer: Brighton Health Commercial |
$199.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$213.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.05
|
| Rate for Payer: Group Health Inc Commercial |
$133.12
|
| Rate for Payer: Group Health Inc Medicare |
$93.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.12
|
|
|
PSYCHOTHERAPY FOR CRISIS,FIRST 30
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
30105103
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
PSYCHOTHERAPY FOR CRISIS,FIRST 30
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
30105103
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
