|
HC PREVENT COUNSEL,INDIV,15 MIN
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 99401
|
| Hospital Charge Code |
5109940101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.18
|
| Rate for Payer: Aetna Government |
$18.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$130.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$130.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.86
|
| Rate for Payer: Amida Care Medicaid |
$57.86
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$130.18
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$57.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.75
|
| 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 |
$57.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.86
|
| Rate for Payer: Healthfirst Essential Plan |
$130.18
|
| Rate for Payer: Healthfirst QHP |
$94.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.86
|
| Rate for Payer: SOMOS Essential |
$130.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$130.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$63.64
|
| Rate for Payer: United Healthcare Medicaid |
$57.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$57.86
|
|
|
HC PREVENT COUNSEL,INDIV,15 MIN
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 99401
|
| Hospital Charge Code |
5109940101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$44.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.50
|
|
|
HC PREVENT COUNSEL,INDIV,45 MIN
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99403
|
| Hospital Charge Code |
5109940301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.00
|
|
|
HC PREVENT COUNSEL,INDIV,45 MIN
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99403
|
| Hospital Charge Code |
5109940301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.59
|
| Rate for Payer: Aetna Government |
$55.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$233.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$233.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.73
|
| Rate for Payer: Amida Care Medicaid |
$103.73
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$103.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$233.39
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$103.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.91
|
| 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 |
$103.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.73
|
| Rate for Payer: Healthfirst Essential Plan |
$233.39
|
| Rate for Payer: Healthfirst QHP |
$169.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$233.39
|
| Rate for Payer: Optum Medicaid |
$0.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.73
|
| Rate for Payer: SOMOS Essential |
$233.39
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$233.39
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$114.10
|
| Rate for Payer: United Healthcare Medicaid |
$103.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$103.73
|
|
|
HC PREVENTIVE VISIT,EST,12-17
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
5109939401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71.44
|
| Rate for Payer: Aetna Government |
$71.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PREVENTIVE VISIT,EST,12-17
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
5109939401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PREVENTIVE VISIT,EST,18-39
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
5109939501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PREVENTIVE VISIT,EST,18-39
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
5109939501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.27
|
| Rate for Payer: Aetna Government |
$66.27
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PREVENTIVE VISIT,EST,40-64
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
5109939601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PREVENTIVE VISIT,EST,40-64
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
5109939601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.08
|
| Rate for Payer: Aetna Government |
$72.08
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PREVENTIVE VISIT,EST,65 & OVER
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
5109939701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.81 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.81
|
| Rate for Payer: Aetna Government |
$75.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PREVENTIVE VISIT,EST,65 & OVER
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
5109939701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PREVENTIVE VISIT,EST,AGE 1-4
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
5109939201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.75
|
| Rate for Payer: Aetna Government |
$66.75
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PREVENTIVE VISIT,EST,AGE 1-4
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
5109939201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PREVENTIVE VISIT,EST,AGE 5-11
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
5109939301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.88
|
| Rate for Payer: Aetna Government |
$62.88
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PREVENTIVE VISIT,EST,AGE 5-11
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
5109939301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PREVENTIVE VISIT,EST, INFANT < 1 YR
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
5109939101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.50
|
| Rate for Payer: Aetna Government |
$59.50
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$179.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC PREVENTIVE VISIT,EST, INFANT < 1 YR
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
5109939101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC PREVENT MED COUNSELING 60 MIN
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 99404
|
| Hospital Charge Code |
5109940401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.00
|
|
|
HC PREVENT MED COUNSELING 60 MIN
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 99404
|
| Hospital Charge Code |
5109940401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$305.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$150.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.14
|
| Rate for Payer: Aetna Government |
$83.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$305.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$305.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$135.66
|
| Rate for Payer: Amida Care Medicaid |
$135.66
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$135.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$305.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$135.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$305.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.45
|
| 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 |
$135.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.66
|
| Rate for Payer: Healthfirst Essential Plan |
$305.25
|
| Rate for Payer: Healthfirst QHP |
$221.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$305.19
|
| Rate for Payer: Optum Medicaid |
$0.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.66
|
| Rate for Payer: SOMOS Essential |
$305.25
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$305.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$149.23
|
| Rate for Payer: United Healthcare Medicaid |
$135.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.66
|
|
|
HC PREVENT MED COUNSELING GRP 30 MIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 99411
|
| Hospital Charge Code |
5109941101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC PREVENT MED COUNSELING GRP 30 MIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 99411
|
| Hospital Charge Code |
5109941101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.81
|
| Rate for Payer: Aetna Government |
$5.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$31.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| 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 |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.81
|
| Rate for Payer: Optum Medicaid |
$0.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
|
|
HC PREVENT MED COUNSELING GRP 45 MIN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99412
|
| Hospital Charge Code |
5109941201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.41
|
| Rate for Payer: Aetna Government |
$9.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$125.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$125.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.87
|
| Rate for Payer: Amida Care Medicaid |
$55.87
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$55.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$125.70
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$55.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.66
|
| 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 |
$55.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.87
|
| Rate for Payer: Healthfirst Essential Plan |
$125.70
|
| Rate for Payer: Healthfirst QHP |
$91.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.65
|
| Rate for Payer: Optum Medicaid |
$0.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: SOMOS Essential |
$125.70
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$125.70
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61.45
|
| Rate for Payer: United Healthcare Medicaid |
$55.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$55.87
|
|
|
HC PREVENT MED COUNSELING GRP 45 MIN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99412
|
| Hospital Charge Code |
5109941201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.50
|
|
|
HC PRGRMG DEV EVAL IMPLTBL SYS - CARD DEVICE IN CLINIC SUBQ ICD W/ PROG
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
4809326003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.56
|
| Rate for Payer: Aetna Government |
$45.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$31.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$31.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.89
|
| Rate for Payer: Brighton Health Commercial |
$91.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$45.56
|
| Rate for Payer: EmblemHealth Commercial |
$45.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.55
|
| Rate for Payer: Group Health Inc Commercial |
$45.56
|
| Rate for Payer: Group Health Inc Medicare |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.73
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: Humana Medicare |
$46.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.28
|
| Rate for Payer: Wellcare Medicare |
$43.28
|
|
