|
HC CREATE EARDRUM OPENING LOCAL ANES
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
5106943301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.47 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.88
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
|
HC CREATE EARDRUM OPENING LOCAL ANES
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
5106943301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC CREATINE, MB FRACTION - CKMB
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
3018255302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC CREATINE, MB FRACTION - CKMB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
3018255302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.55
|
| Rate for Payer: Aetna Government |
$11.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.09
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.55
|
| Rate for Payer: EmblemHealth Commercial |
$11.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.28
|
| Rate for Payer: Group Health Inc Commercial |
$11.55
|
| Rate for Payer: Group Health Inc Medicare |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.13
|
| Rate for Payer: Healthfirst Essential Plan |
$18.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.55
|
| Rate for Payer: Healthfirst QHP |
$11.55
|
| Rate for Payer: Humana Medicare |
$11.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.13
|
| Rate for Payer: Wellcare Medicare |
$10.39
|
|
|
HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
3018257501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.46
|
| Rate for Payer: Aetna Government |
$9.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.62
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.46
|
| Rate for Payer: EmblemHealth Commercial |
$9.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.42
|
| Rate for Payer: Group Health Inc Commercial |
$9.46
|
| Rate for Payer: Group Health Inc Medicare |
$9.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.89
|
| Rate for Payer: Healthfirst Essential Plan |
$13.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.46
|
| Rate for Payer: Healthfirst QHP |
$9.46
|
| Rate for Payer: Humana Medicare |
$9.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$11.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.89
|
| Rate for Payer: Wellcare Medicare |
$8.51
|
|
|
HC CREATININE CLEARANCE TEST - CREATININE CLEARANCE, URINE, 24 HOUR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
3018257501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
HC CRISIS F/UP TELEPHONIC (<90 MIN)-LICENSED
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT H2011 TS,GT
|
| Hospital Charge Code |
911H201104
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
|
|
HC CRISIS F/UP TELEPHONIC (<90 MIN)-LICENSED
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT H2011 TS,GT
|
| Hospital Charge Code |
911H201104
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$208.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.79
|
| Rate for Payer: Aetna Government |
$7.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$92.57
|
| Rate for Payer: Amida Care Medicaid |
$92.57
|
| Rate for Payer: Brighton Health Commercial |
$108.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.60
|
| Rate for Payer: EmblemHealth Commercial |
$72.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$208.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$92.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.20
|
| Rate for Payer: Group Health Inc Commercial |
$72.50
|
| Rate for Payer: Group Health Inc Medicare |
$50.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.57
|
| Rate for Payer: Healthfirst Essential Plan |
$208.29
|
| Rate for Payer: Healthfirst QHP |
$150.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.29
|
| Rate for Payer: Optum Medicaid |
$0.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: SOMOS Essential |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$101.83
|
| Rate for Payer: United Healthcare Medicaid |
$92.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$92.57
|
|
|
HC CRISIS F/UP TELEPHONIC (<90 MIN)-UNLICENSED
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT H2011 TS,HM
|
| Hospital Charge Code |
911H201105
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$29.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.50
|
|
|
HC CRISIS F/UP TELEPHONIC (<90 MIN)-UNLICENSED
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT H2011 TS,HM
|
| Hospital Charge Code |
911H201105
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$208.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.79
|
| Rate for Payer: Aetna Government |
$7.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$92.57
|
| Rate for Payer: Amida Care Medicaid |
$92.57
|
| Rate for Payer: Brighton Health Commercial |
$44.25
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.12
|
| Rate for Payer: EmblemHealth Commercial |
$29.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$208.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$92.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.20
|
| Rate for Payer: Group Health Inc Commercial |
$29.50
|
| Rate for Payer: Group Health Inc Medicare |
$20.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.57
|
| Rate for Payer: Healthfirst Essential Plan |
$208.29
|
| Rate for Payer: Healthfirst QHP |
$150.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.29
|
| Rate for Payer: Optum Medicaid |
$0.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: SOMOS Essential |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$101.83
|
| Rate for Payer: United Healthcare Medicaid |
$92.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$92.57
|
|
|
HC CRISIS INTERVENTION MENTAL HEALTH SERV, PER DIEM
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT S9485
|
| Hospital Charge Code |
905S948501
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$626.50 |
| Max. Negotiated Rate |
$626.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$626.50
|
|
|
HC CRISIS INTERVENTION MENTAL HEALTH SERV, PER DIEM
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT S9485
|
| Hospital Charge Code |
905S948501
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$3,016.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$689.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.29
|
| Rate for Payer: Aetna Government |
$69.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,016.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,340.60
|
| Rate for Payer: Amida Care Medicaid |
$1,340.60
|
| Rate for Payer: Brighton Health Commercial |
$939.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,340.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,002.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$852.04
|
| Rate for Payer: EmblemHealth Commercial |
$626.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$1,340.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,340.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,016.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,016.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,407.63
|
| Rate for Payer: Group Health Inc Commercial |
$626.50
|
| Rate for Payer: Group Health Inc Medicare |
$438.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,340.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,340.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,340.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,016.37
|
| Rate for Payer: Healthfirst QHP |
$2,185.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,340.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,016.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,016.37
|
| Rate for Payer: Optum Commercial/Medicare |
$143.00
|
| Rate for Payer: Optum Medicaid |
$5.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,340.60
|
| Rate for Payer: SOMOS Essential |
$3,016.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,474.65
|
| Rate for Payer: United Healthcare Medicaid |
$1,340.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,340.60
|
|
|
HC CRISIS INTERVENTION MENTAL HEALTH SERV, PER HOUR
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT S9484
|
| Hospital Charge Code |
900S948401
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$1,256.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.79
|
| Rate for Payer: Aetna Government |
$24.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,256.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,256.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$558.58
|
| Rate for Payer: Amida Care Medicaid |
$558.58
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$558.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: EmblemHealth Commercial |
$125.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$1,256.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$558.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$558.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,256.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,256.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$586.50
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$558.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,256.81
|
| Rate for Payer: Healthfirst QHP |
$910.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$558.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,256.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,256.81
|
| Rate for Payer: Optum Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$558.58
|
| Rate for Payer: SOMOS Essential |
$1,256.81
|
| Rate for Payer: United Healthcare Commercial |
$125.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,256.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$614.43
|
| Rate for Payer: United Healthcare Medicaid |
$558.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$558.58
|
|
|
HC CRISIS INTERVENTION MENTAL HEALTH SERV, PER HOUR
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT S9484
|
| Hospital Charge Code |
900S948401
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
|
|
HC CRISIS INTERVENTION, PER 15 MIN
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT H2011
|
| Hospital Charge Code |
911H201101
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
|
|
HC CRISIS INTERVENTION, PER 15 MIN
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT H2011
|
| Hospital Charge Code |
911H201101
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$208.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.79
|
| Rate for Payer: Aetna Government |
$7.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$92.57
|
| Rate for Payer: Amida Care Medicaid |
$92.57
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: EmblemHealth Commercial |
$125.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$208.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$92.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.20
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.57
|
| Rate for Payer: Healthfirst Essential Plan |
$208.29
|
| Rate for Payer: Healthfirst QHP |
$150.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.29
|
| Rate for Payer: Optum Medicaid |
$0.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: SOMOS Essential |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$101.83
|
| Rate for Payer: United Healthcare Medicaid |
$92.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$92.57
|
|
|
HC CRISIS RESPONSE TELEPHONIC (<90 MIN)-LICENSED
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT H2011 GT
|
| Hospital Charge Code |
911H201102
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$208.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.79
|
| Rate for Payer: Aetna Government |
$7.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$92.57
|
| Rate for Payer: Amida Care Medicaid |
$92.57
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: EmblemHealth Commercial |
$125.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$208.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$92.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.20
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.57
|
| Rate for Payer: Healthfirst Essential Plan |
$208.29
|
| Rate for Payer: Healthfirst QHP |
$150.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.29
|
| Rate for Payer: Optum Medicaid |
$0.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: SOMOS Essential |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$101.83
|
| Rate for Payer: United Healthcare Medicaid |
$92.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$92.57
|
|
|
HC CRISIS RESPONSE TELEPHONIC (<90 MIN)-LICENSED
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT H2011 GT
|
| Hospital Charge Code |
911H201102
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
|
|
HC CRISIS RESPONSE TELEPHONIC (>90 MIN)-LICENSED
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT S9485 GT
|
| Hospital Charge Code |
905S948502
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$738.00 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$738.00
|
|
|
HC CRISIS RESPONSE TELEPHONIC (>90 MIN)-LICENSED
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT S9485 GT
|
| Hospital Charge Code |
905S948502
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$3,016.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$811.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.28
|
| Rate for Payer: Aetna Government |
$63.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,016.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,340.60
|
| Rate for Payer: Amida Care Medicaid |
$1,340.60
|
| Rate for Payer: Brighton Health Commercial |
$1,107.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,340.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,180.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,003.68
|
| Rate for Payer: EmblemHealth Commercial |
$738.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$1,340.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,340.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,016.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,016.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,407.63
|
| Rate for Payer: Group Health Inc Commercial |
$738.00
|
| Rate for Payer: Group Health Inc Medicare |
$516.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,340.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,340.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,340.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,016.37
|
| Rate for Payer: Healthfirst QHP |
$2,185.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,340.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,016.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,016.37
|
| Rate for Payer: Optum Commercial/Medicare |
$143.00
|
| Rate for Payer: Optum Medicaid |
$5.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,340.60
|
| Rate for Payer: SOMOS Essential |
$3,016.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,474.65
|
| Rate for Payer: United Healthcare Medicaid |
$1,340.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,340.60
|
|
|
HC CRISIS RESPONSE TELEPHONIC (<90 MIN)-UNLICENSED
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT H2011 GT,HO
|
| Hospital Charge Code |
911H201103
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.00
|
|
|
HC CRISIS RESPONSE TELEPHONIC (<90 MIN)-UNLICENSED
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT H2011 GT,HO
|
| Hospital Charge Code |
911H201103
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$208.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.79
|
| Rate for Payer: Aetna Government |
$7.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$92.57
|
| Rate for Payer: Amida Care Medicaid |
$92.57
|
| Rate for Payer: Brighton Health Commercial |
$73.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.64
|
| Rate for Payer: EmblemHealth Commercial |
$49.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$208.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$92.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.20
|
| Rate for Payer: Group Health Inc Commercial |
$49.00
|
| Rate for Payer: Group Health Inc Medicare |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.57
|
| Rate for Payer: Healthfirst Essential Plan |
$208.29
|
| Rate for Payer: Healthfirst QHP |
$150.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.29
|
| Rate for Payer: Optum Medicaid |
$0.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.57
|
| Rate for Payer: SOMOS Essential |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$208.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$101.83
|
| Rate for Payer: United Healthcare Medicaid |
$92.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$92.57
|
|
|
HC CRISIS RESPONSE TELEPHONIC (>90 MIN)-UNLICENSED
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT S9485 HO
|
| Hospital Charge Code |
905S948503
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$442.50
|
|
|
HC CRISIS RESPONSE TELEPHONIC (>90 MIN)-UNLICENSED
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT S9485 HO
|
| Hospital Charge Code |
905S948503
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$3,016.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$486.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.28
|
| Rate for Payer: Aetna Government |
$63.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,016.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,340.60
|
| Rate for Payer: Amida Care Medicaid |
$1,340.60
|
| Rate for Payer: Brighton Health Commercial |
$663.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,340.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$708.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.80
|
| Rate for Payer: EmblemHealth Commercial |
$442.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$1,340.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,340.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,016.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,016.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,407.63
|
| Rate for Payer: Group Health Inc Commercial |
$442.50
|
| Rate for Payer: Group Health Inc Medicare |
$309.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,340.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,340.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,340.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,016.37
|
| Rate for Payer: Healthfirst QHP |
$2,185.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,340.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,016.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,016.37
|
| Rate for Payer: Optum Commercial/Medicare |
$143.00
|
| Rate for Payer: Optum Medicaid |
$5.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,340.60
|
| Rate for Payer: SOMOS Essential |
$3,016.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,016.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,474.65
|
| Rate for Payer: United Healthcare Medicaid |
$1,340.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,340.60
|
|
|
HC CRITICAL CARE, ADDL 30 MIN
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
6819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$249.50 |
| Max. Negotiated Rate |
$249.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.50
|
|
