|
PSYCL/NRPSYC TECH 1ST
|
Facility
|
OP
|
$209.52
|
|
|
Service Code
|
HCPCS 96138
|
| Hospital Charge Code |
30307929
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$104.76 |
| Max. Negotiated Rate |
$17,410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.76
|
| Rate for Payer: Aetna Government |
$460.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$391.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$391.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$174.10
|
| Rate for Payer: Amida Care Medicaid |
$174.10
|
| Rate for Payer: Brighton Health Commercial |
$157.14
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$175.69
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$460.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$460.76
|
| Rate for Payer: EmblemHealth Commercial |
$460.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.80
|
| Rate for Payer: Group Health Inc Commercial |
$460.76
|
| Rate for Payer: Group Health Inc Medicare |
$460.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.10
|
| Rate for Payer: Healthfirst Essential Plan |
$391.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.65
|
| Rate for Payer: Healthfirst QHP |
$174.10
|
| Rate for Payer: Humana Medicare |
$469.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.30
|
| Rate for Payer: Optum Medicaid |
$175.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.10
|
| Rate for Payer: SOMOS Essential |
$391.72
|
| Rate for Payer: United Healthcare Commercial |
$104.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$391.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$191.51
|
| Rate for Payer: United Healthcare Medicaid |
$174.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.61
|
| Rate for Payer: Wellcare Medicare |
$437.72
|
|
|
PSYCL/NRPSYC TECH 1ST
|
Facility
|
IP
|
$209.52
|
|
|
Service Code
|
HCPCS 96138
|
| Hospital Charge Code |
30307929
|
|
Hospital Revenue Code
|
918
|
| Rate for Payer: Cash Price |
$460.76
|
|
|
PSYCL/NRPSYC TST AUTO RESULT
|
Facility
|
IP
|
$69.63
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
30307931
|
|
Hospital Revenue Code
|
918
|
| Rate for Payer: Cash Price |
$34.43
|
|
|
PSYCL/NRPSYC TST AUTO RESULT
|
Facility
|
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
30307931
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$55.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Brighton Health Commercial |
$52.22
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.27
|
| Rate for Payer: Humana Medicare |
$35.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Commercial |
$34.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$32.71
|
|
|
PSYCL/NRPSYC TST PHY/QHP 1ST
|
Facility
|
OP
|
$209.52
|
|
|
Service Code
|
HCPCS 96136
|
| Hospital Charge Code |
30307927
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$104.76 |
| Max. Negotiated Rate |
$17,410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$391.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$391.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$174.10
|
| Rate for Payer: Amida Care Medicaid |
$174.10
|
| Rate for Payer: Brighton Health Commercial |
$157.14
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$175.69
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.80
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.10
|
| Rate for Payer: Healthfirst Essential Plan |
$391.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$174.10
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.30
|
| Rate for Payer: Optum Medicaid |
$175.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.10
|
| Rate for Payer: SOMOS Essential |
$391.72
|
| Rate for Payer: United Healthcare Commercial |
$104.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$391.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$191.51
|
| Rate for Payer: United Healthcare Medicaid |
$174.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
PSYCL/NRPSYC TST PHY/QHP 1ST
|
Facility
|
IP
|
$209.52
|
|
|
Service Code
|
HCPCS 96136
|
| Hospital Charge Code |
30307927
|
|
Hospital Revenue Code
|
918
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
PSYCL/NRPSYC TST PHY/QHP EA
|
Facility
|
OP
|
$209.52
|
|
|
Service Code
|
HCPCS 96137
|
| Hospital Charge Code |
30307928
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$9,674.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.40
|
| Rate for Payer: Aetna Government |
$16.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$96.74
|
| Rate for Payer: Amida Care Medicaid |
$96.74
|
| Rate for Payer: Brighton Health Commercial |
$157.14
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$97.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,674.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.58
|
| Rate for Payer: Group Health Inc Commercial |
$104.76
|
| Rate for Payer: Group Health Inc Medicare |
$73.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.74
|
| Rate for Payer: Healthfirst Essential Plan |
$217.66
|
| Rate for Payer: Healthfirst QHP |
$96.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.64
|
| Rate for Payer: Optum Medicaid |
$97.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.74
|
| Rate for Payer: SOMOS Essential |
$217.66
|
| Rate for Payer: United Healthcare Commercial |
$104.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$217.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$106.41
|
| Rate for Payer: United Healthcare Medicaid |
$96.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$96.74
|
|
|
PSYCL/NRPSYC TST TECH EA
|
Facility
|
OP
|
$209.52
|
|
|
Service Code
|
HCPCS 96139
|
| Hospital Charge Code |
30307930
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$9,674.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.02
|
| Rate for Payer: Aetna Government |
$35.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$96.74
|
| Rate for Payer: Amida Care Medicaid |
$96.74
|
| Rate for Payer: Brighton Health Commercial |
$157.14
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$97.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,674.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.58
|
| Rate for Payer: Group Health Inc Commercial |
$104.76
|
| Rate for Payer: Group Health Inc Medicare |
$73.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.74
|
| Rate for Payer: Healthfirst Essential Plan |
$217.66
|
| Rate for Payer: Healthfirst QHP |
$96.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.64
|
| Rate for Payer: Optum Medicaid |
$97.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.74
|
| Rate for Payer: SOMOS Essential |
$217.66
|
| Rate for Payer: United Healthcare Commercial |
$104.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$217.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$106.41
|
| Rate for Payer: United Healthcare Medicaid |
$96.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$96.74
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
30307923
|
|
Hospital Revenue Code
|
918
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
30307923
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$96.74 |
| Max. Negotiated Rate |
$9,674.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$96.74
|
| Rate for Payer: Amida Care Medicaid |
$96.74
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$97.62
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,674.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.58
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.74
|
| Rate for Payer: Healthfirst Essential Plan |
$217.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$96.74
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.64
|
| Rate for Payer: Optum Medicaid |
$97.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.74
|
| Rate for Payer: SOMOS Essential |
$217.66
|
| Rate for Payer: United Healthcare Commercial |
$209.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$217.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$106.41
|
| Rate for Payer: United Healthcare Medicaid |
$96.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 96131
|
| Hospital Charge Code |
30307924
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$70.24 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.24
|
| Rate for Payer: Aetna Government |
$70.24
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: United Healthcare Commercial |
$209.52
|
|
|
PSYLLIUM 3.4 GRAM PACKET
|
Facility
|
OP
|
$0.28
|
|
| Hospital Charge Code |
41657006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
PSYLLIUM 3.4 GRAM PACKET
|
Facility
|
OP
|
$0.28
|
|
| Hospital Charge Code |
41647006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
PSYTX COMPLETE INTERACTIVE
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
30305502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.08
|
| Rate for Payer: Aetna Government |
$17.08
|
| Rate for Payer: Brighton Health Commercial |
$121.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.25
|
| Rate for Payer: Group Health Inc Medicare |
$56.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
| Rate for Payer: United Healthcare Commercial |
$81.25
|
|
|
PSYTX PT &/FAMILY 30 MIN
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
30305505
|
|
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
|
|
|
PSYTX PT &/FAMILY 30 MIN
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
30305505
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PSYTX PT&/FAMILY 30 MIN
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
30305736
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PSYTX PT&/FAMILY 30 MIN
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
30305736
|
|
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
|
|
|
PSYTX PT&/FAMILY 45 MIN
|
Facility
|
OP
|
$275.22
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
30305730
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.33 |
| Max. Negotiated Rate |
$12,188.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$133.75
|
| Rate for Payer: Aetna Government |
$133.75
|
| 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 |
$206.42
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$122.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$220.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.15
|
| 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 |
$137.61
|
| Rate for Payer: Group Health Inc Medicare |
$96.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.61
|
| 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
|
|
|
PSYTX PT/FAMILY W/ E&M 30 MIN
|
Facility
|
OP
|
$180.45
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
30305733
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$63.16 |
| Max. Negotiated Rate |
$7,835.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90.95
|
| Rate for Payer: Aetna Government |
$90.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$176.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$176.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.35
|
| Rate for Payer: Amida Care Medicaid |
$78.35
|
| Rate for Payer: Brighton Health Commercial |
$135.34
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$79.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,835.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.27
|
| Rate for Payer: Group Health Inc Commercial |
$90.22
|
| Rate for Payer: Group Health Inc Medicare |
$63.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.35
|
| Rate for Payer: Healthfirst Essential Plan |
$176.29
|
| Rate for Payer: Healthfirst QHP |
$78.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.88
|
| Rate for Payer: Optum Medicaid |
$79.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.35
|
| Rate for Payer: SOMOS Essential |
$176.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$176.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$86.18
|
| Rate for Payer: United Healthcare Medicaid |
$78.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.35
|
|
|
PSYTX PT&/FMAILY W/E&M 45 MIN
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30305731
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
PSYTX PT&/FMAILY W/E&M 45 MIN
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30305731
|
|
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
|
|
|
PT 1ST BIOLOG ANTIRHEUM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2182
|
| Hospital Charge Code |
30300310
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
PT 50-85 W/ SCOPE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2204
|
| Hospital Charge Code |
30300332
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
PT 50 YRS W/CLIN IND HD
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2188
|
| Hospital Charge Code |
30300316
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
