|
HC PROTOZOA, NOT ELSEWHERE - TRYPANOSOMA CRUZI ANTIBODY, IGG
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
3028675303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
HC PROVE NASOLACRIMAL DUCT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
5106881001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$406.00 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.00
|
|
|
HC PROVE NASOLACRIMAL DUCT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
5106881001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.93 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| 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 |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| 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 |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL
|
Facility
|
OP
|
$9,417.00
|
|
|
Service Code
|
CPT 47533 TC
|
| Hospital Charge Code |
3614753301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$7,062.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$350.02
|
| Rate for Payer: Aetna Government |
$350.02
|
| Rate for Payer: Brighton Health Commercial |
$7,062.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$4,708.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,708.50
|
| Rate for Payer: Group Health Inc Medicare |
$3,295.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,685.17
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL
|
Facility
|
IP
|
$9,417.00
|
|
|
Service Code
|
CPT 47533 TC
|
| Hospital Charge Code |
3614753301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,708.50 |
| Max. Negotiated Rate |
$4,708.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
|
|
HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT
|
Facility
|
IP
|
$10,439.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
3614753401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,219.50 |
| Max. Negotiated Rate |
$5,219.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,219.50
|
|
|
HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT
|
Facility
|
OP
|
$10,439.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
3614753401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$7,829.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,311.88
|
| Rate for Payer: Aetna Government |
$4,311.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,018.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,018.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,018.32
|
| Rate for Payer: Brighton Health Commercial |
$7,829.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,311.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,311.88
|
| Rate for Payer: EmblemHealth Commercial |
$4,311.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,880.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,665.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,837.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,311.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,837.57
|
| Rate for Payer: Group Health Inc Commercial |
$4,311.88
|
| Rate for Payer: Group Health Inc Medicare |
$4,311.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,311.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,685.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,665.10
|
| Rate for Payer: Healthfirst QHP |
$4,311.88
|
| Rate for Payer: Humana Medicare |
$4,398.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,311.88
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,311.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,311.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,096.29
|
| Rate for Payer: Wellcare Medicare |
$4,096.29
|
|
|
HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
4819292801
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
4819292801
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$676.51 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13,856.14
|
| Rate for Payer: Aetna Government |
$13,856.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9,699.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9,699.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9,699.30
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13,856.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$13,856.14
|
| Rate for Payer: EmblemHealth Commercial |
$13,856.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12,470.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11,777.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12,331.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,856.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12,331.96
|
| Rate for Payer: Group Health Inc Commercial |
$13,856.14
|
| Rate for Payer: Group Health Inc Medicare |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,994.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$676.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,777.72
|
| Rate for Payer: Healthfirst QHP |
$13,856.14
|
| Rate for Payer: Humana Medicare |
$14,133.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13,856.14
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,856.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13,856.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13,163.33
|
| Rate for Payer: Wellcare Medicare |
$13,163.33
|
|
|
HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
|
Facility
|
OP
|
$30,948.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
4819294101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$635.26 |
| Max. Negotiated Rate |
$17,021.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,021.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$635.26
|
| Rate for Payer: Aetna Government |
$635.26
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: EmblemHealth Commercial |
$15,474.00
|
| Rate for Payer: Group Health Inc Commercial |
$15,474.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,831.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,474.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,474.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$760.42
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL
|
Facility
|
IP
|
$30,948.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
4819294101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,474.00 |
| Max. Negotiated Rate |
$15,474.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,474.00
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
9009079101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$137.42 |
| Max. Negotiated Rate |
$317.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.31
|
| Rate for Payer: Aetna Government |
$196.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$137.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$137.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$137.42
|
| Rate for Payer: Brighton Health Commercial |
$297.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$317.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$269.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$196.31
|
| Rate for Payer: EmblemHealth Commercial |
$196.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.72
|
| Rate for Payer: Group Health Inc Commercial |
$196.31
|
| Rate for Payer: Group Health Inc Medicare |
$196.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.86
|
| Rate for Payer: Healthfirst QHP |
$196.31
|
| Rate for Payer: Humana Medicare |
$200.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.31
|
| Rate for Payer: United Healthcare Commercial |
$198.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$186.49
|
| Rate for Payer: Wellcare Medicare |
$186.49
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
9009079101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.50
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
9009079201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.50
|
|
|
HC PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
9009079201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$137.42 |
| Max. Negotiated Rate |
$317.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.31
|
| Rate for Payer: Aetna Government |
$196.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$137.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$137.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$137.42
|
| Rate for Payer: Brighton Health Commercial |
$297.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$317.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$269.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$196.31
|
| Rate for Payer: EmblemHealth Commercial |
$196.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.72
|
| Rate for Payer: Group Health Inc Commercial |
$196.31
|
| Rate for Payer: Group Health Inc Medicare |
$196.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.86
|
| Rate for Payer: Healthfirst QHP |
$196.31
|
| Rate for Payer: Humana Medicare |
$200.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.31
|
| Rate for Payer: United Healthcare Commercial |
$198.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$186.49
|
| Rate for Payer: Wellcare Medicare |
$186.49
|
|
|
HC PSYCHIATRIC PRIVATE
|
Facility
|
IP
|
$4,209.00
|
|
| Hospital Charge Code |
1240000002
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$2,104.50 |
| Rate for Payer: Amida Care Medicaid |
$800.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$760.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$860.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,085.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,085.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,104.50
|
| Rate for Payer: Optum Commercial/Medicare |
$776.00
|
| Rate for Payer: Optum Medicaid |
$761.00
|
|
|
HC PSYCHIATRIC SERVICE/THERAPY
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
9199089901
|
|
Hospital Revenue Code
|
919
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC PSYCHIATRIC SERVICE/THERAPY
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
9199089901
|
|
Hospital Revenue Code
|
919
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.40
|
| Rate for Payer: Aetna Government |
$36.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.48
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$36.40
|
| Rate for Payer: EmblemHealth Commercial |
$36.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.40
|
| Rate for Payer: Group Health Inc Commercial |
$36.40
|
| Rate for Payer: Group Health Inc Medicare |
$36.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.94
|
| Rate for Payer: Healthfirst QHP |
$36.40
|
| Rate for Payer: Humana Medicare |
$37.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.58
|
| Rate for Payer: Wellcare Medicare |
$34.58
|
|
|
HC PSYCHISTRIC SEMI-PRIVATE
|
Facility
|
IP
|
$4,093.00
|
|
| Hospital Charge Code |
1240000001
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$2,046.50 |
| Rate for Payer: Amida Care Medicaid |
$800.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$760.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$860.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,085.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,085.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,046.50
|
| Rate for Payer: Optum Commercial/Medicare |
$776.00
|
| Rate for Payer: Optum Medicaid |
$761.00
|
|
|
HC PSYCHOTHERAPY, 60 MIN PT/FAM E&M
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
9149083801
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$301.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.81
|
| Rate for Payer: Aetna Government |
$153.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$301.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$301.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.07
|
| Rate for Payer: Amida Care Medicaid |
$134.07
|
| Rate for Payer: Brighton Health Commercial |
$222.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$134.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$236.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.28
|
| Rate for Payer: EmblemHealth Commercial |
$148.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$301.65
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$134.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$301.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.77
|
| Rate for Payer: Group Health Inc Commercial |
$148.00
|
| Rate for Payer: Group Health Inc Medicare |
$103.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.07
|
| Rate for Payer: Healthfirst Essential Plan |
$301.65
|
| Rate for Payer: Healthfirst QHP |
$218.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$301.65
|
| Rate for Payer: Optum Medicaid |
$0.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.07
|
| Rate for Payer: SOMOS Essential |
$301.65
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$301.65
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$147.47
|
| Rate for Payer: United Healthcare Medicaid |
$134.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$134.07
|
|
|
HC PSYCHOTHERAPY, 60 MIN PT/FAM E&M
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
9149083801
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.00
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
9149078501
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
9149078501
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.08
|
| Rate for Payer: Aetna Government |
$17.08
|
| Rate for Payer: Brighton Health Commercial |
$121.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.16
|
| Rate for Payer: EmblemHealth Commercial |
$81.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.54
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
9149078502
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
9149078502
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.08
|
| Rate for Payer: Aetna Government |
$17.08
|
| Rate for Payer: Brighton Health Commercial |
$121.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.16
|
| Rate for Payer: EmblemHealth Commercial |
$81.00
|
| Rate for Payer: Group Health Inc Commercial |
$81.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.54
|
|
