|
HC MITOCHONDRIAL ANTIBODY (EG, M2), EACH
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
3028638101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.45
|
| Rate for Payer: Aetna Government |
$25.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.82
|
| Rate for Payer: Brighton Health Commercial |
$62.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.45
|
| Rate for Payer: EmblemHealth Commercial |
$25.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.65
|
| Rate for Payer: Group Health Inc Commercial |
$25.45
|
| Rate for Payer: Group Health Inc Medicare |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.42
|
| Rate for Payer: Healthfirst Essential Plan |
$34.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.45
|
| Rate for Payer: Healthfirst QHP |
$25.45
|
| Rate for Payer: Humana Medicare |
$25.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare Commercial |
$22.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.42
|
| Rate for Payer: Wellcare Medicare |
$22.91
|
|
|
HC MITOCHONDRIAL ANTIBODY (EG, M2), EACH
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
3028638101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.50
|
|
|
HC MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81292
|
| Hospital Charge Code |
3108129201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81292
|
| Hospital Charge Code |
3108129201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$1,468.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$675.40
|
| Rate for Payer: Aetna Government |
$675.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$472.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$472.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$472.78
|
| Rate for Payer: Brighton Health Commercial |
$675.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$675.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$675.40
|
| Rate for Payer: EmblemHealth Commercial |
$675.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$607.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$574.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$601.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$675.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$601.11
|
| Rate for Payer: Group Health Inc Commercial |
$675.40
|
| Rate for Payer: Group Health Inc Medicare |
$675.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$675.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$675.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$652.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,468.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$675.40
|
| Rate for Payer: Healthfirst QHP |
$675.40
|
| Rate for Payer: Humana Medicare |
$688.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$675.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$675.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$652.70
|
| Rate for Payer: Wellcare Medicare |
$607.86
|
|
|
HC MLH1 (MUTL HOMOLOG 1, COLON CANCER, NONPOLYPOSIS TYPE 2)
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 81294
|
| Hospital Charge Code |
3108129401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.65 |
| Max. Negotiated Rate |
$433.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$202.40
|
| Rate for Payer: Aetna Government |
$202.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$141.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$141.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$141.68
|
| Rate for Payer: Brighton Health Commercial |
$202.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$202.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$202.40
|
| Rate for Payer: EmblemHealth Commercial |
$202.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.14
|
| Rate for Payer: Group Health Inc Commercial |
$202.40
|
| Rate for Payer: Group Health Inc Medicare |
$202.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.59
|
| Rate for Payer: Healthfirst Essential Plan |
$433.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.40
|
| Rate for Payer: Healthfirst QHP |
$202.40
|
| Rate for Payer: Humana Medicare |
$206.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$192.59
|
| Rate for Payer: Wellcare Medicare |
$182.16
|
|
|
HC MLH1 (MUTL HOMOLOG 1, COLON CANCER, NONPOLYPOSIS TYPE 2)
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 81294
|
| Hospital Charge Code |
3108129401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$81.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.50
|
|
|
HC MMR VIRUS IMMUNIZATION, SUBCUT
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
6369070701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$89.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$89.72
|
| Rate for Payer: Aetna Government |
$89.72
|
| Rate for Payer: Brighton Health Commercial |
$61.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.65
|
| Rate for Payer: EmblemHealth Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Commercial |
$51.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
|
|
HC MMR VIRUS IMMUNIZATION, SUBCUT
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
6369070701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.00
|
|
|
HC MOBILE CRISIS F/UP-1 PERSON RESPONSE, LICENSED
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT H2011 TS
|
| Hospital Charge Code |
911H201109
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
|
|
HC MOBILE CRISIS F/UP-1 PERSON RESPONSE, LICENSED
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT H2011 TS
|
| Hospital Charge Code |
911H201109
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$208.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| 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 |
$163.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$174.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$148.24
|
| Rate for Payer: EmblemHealth Commercial |
$109.00
|
| 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 |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| 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 MOBILE CRISIS F/UP-2 PERSON RESPONSE, BOTH LICENSED
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT H2011 TS,SC
|
| Hospital Charge Code |
911H201111
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
|
|
HC MOBILE CRISIS F/UP-2 PERSON RESPONSE, BOTH LICENSED
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT H2011 TS,SC
|
| Hospital Charge Code |
911H201111
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| 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 |
$225.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: EmblemHealth Commercial |
$150.00
|
| 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 |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| 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 MOBILE CRISIS F/UP-2 PERSON RESPONSE-LICENSED+UNLICENSED
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT H2011 TS,HE
|
| Hospital Charge Code |
911H201110
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$208.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| 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 |
$61.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| 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 |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| 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 MOBILE CRISIS F/UP-2 PERSON RESPONSE-LICENSED+UNLICENSED
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT H2011 TS,HE
|
| Hospital Charge Code |
911H201110
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC MOBILE CRISIS RESPONSE-1 PERSON RESPONSE, LICENSED (<90 MIN)
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT H2011 HE
|
| Hospital Charge Code |
911H201106
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.10
|
| 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 |
$196.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$209.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.16
|
| Rate for Payer: EmblemHealth Commercial |
$131.00
|
| 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 |
$131.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.70
|
| 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 MOBILE CRISIS RESPONSE-1 PERSON RESPONSE, LICENSED (<90 MIN)
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT H2011 HE
|
| Hospital Charge Code |
911H201106
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.00
|
|
|
HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE, BOTH LICENSED (>3 HRS)
|
Facility
|
OP
|
$6,297.00
|
|
|
Service Code
|
CPT S9485 HE,HK
|
| Hospital Charge Code |
905S948507
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$5,037.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,463.35
|
| 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 |
$4,722.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,340.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,037.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,281.96
|
| Rate for Payer: EmblemHealth Commercial |
$3,148.50
|
| 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 |
$3,148.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,203.95
|
| 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 MOBILE CRISIS RESPONSE-2 PERSON RESPONSE, BOTH LICENSED (>3 HRS)
|
Facility
|
IP
|
$6,297.00
|
|
|
Service Code
|
CPT S9485 HE,HK
|
| Hospital Charge Code |
905S948507
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$3,148.50 |
| Max. Negotiated Rate |
$3,148.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,148.50
|
|
|
HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE, BOTH LICENSED (<90 MIN)
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT H2011 HE,HK
|
| Hospital Charge Code |
911H201108
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.00
|
|
|
HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE, BOTH LICENSED (<90 MIN)
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT H2011 HE,HK
|
| Hospital Charge Code |
911H201108
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$419.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$288.20
|
| 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 |
$393.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$92.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$419.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$356.32
|
| Rate for Payer: EmblemHealth Commercial |
$262.00
|
| 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 |
$262.00
|
| Rate for Payer: Group Health Inc Medicare |
$183.40
|
| 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 MOBILE CRISIS RESPONSE-2 PERSON RESPONSE, BOTH LICENSED (91-180 MIN)
|
Facility
|
IP
|
$4,723.00
|
|
|
Service Code
|
CPT S9485 HE,HK,U5
|
| Hospital Charge Code |
905S948505
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$2,361.50 |
| Max. Negotiated Rate |
$2,361.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,361.50
|
|
|
HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE, BOTH LICENSED (91-180 MIN)
|
Facility
|
OP
|
$4,723.00
|
|
|
Service Code
|
CPT S9485 HE,HK,U5
|
| Hospital Charge Code |
905S948505
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$3,778.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,597.65
|
| 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 |
$3,542.25
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,340.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,778.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,211.64
|
| Rate for Payer: EmblemHealth Commercial |
$2,361.50
|
| 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 |
$2,361.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,653.05
|
| 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 MOBILE CRISIS RESPONSE-2 PERSON RESPONSE-LICENSED+UNLICENSED(>3 HRS)
|
Facility
|
OP
|
$4,273.00
|
|
|
Service Code
|
CPT S9485 HE
|
| Hospital Charge Code |
905S948506
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$3,418.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,350.15
|
| 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 |
$3,204.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,340.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,418.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,905.64
|
| Rate for Payer: EmblemHealth Commercial |
$2,136.50
|
| 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 |
$2,136.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,495.55
|
| 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 MOBILE CRISIS RESPONSE-2 PERSON RESPONSE-LICENSED+UNLICENSED(>3 HRS)
|
Facility
|
IP
|
$4,273.00
|
|
|
Service Code
|
CPT S9485 HE
|
| Hospital Charge Code |
905S948506
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$2,136.50 |
| Max. Negotiated Rate |
$2,136.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,136.50
|
|
|
HC MOBILE CRISIS RESPONSE-2 PERSON RESPONSE-LICENSED+UNLICENSED(<90 MIN)
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT H2011 HK
|
| Hospital Charge Code |
911H201107
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.00
|
|
