|
HC PSYCHOTHERAPY FOR CRISIS, EACH ADD'L 30 MINS
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
9149084001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.21
|
| Rate for Payer: Aetna Government |
$78.21
|
| Rate for Payer: Brighton Health Commercial |
$199.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$212.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.88
|
| Rate for Payer: EmblemHealth Commercial |
$133.00
|
| Rate for Payer: Group Health Inc Commercial |
$133.00
|
| Rate for Payer: Group Health Inc Medicare |
$93.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.85
|
|
|
HC PSYCHOTHERAPY FOR CRISIS, EACH ADD'L 30 MINS
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
9149084001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.00
|
|
|
HC PSYCHOTHERAPY FOR CRISIS, FIRST 60 MINS
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
9149083901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.50
|
|
|
HC PSYCHOTHERAPY FOR CRISIS, FIRST 60 MINS
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
9149083901
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$137.42 |
| Max. Negotiated Rate |
$317.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| 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 |
$143.75
|
| 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: Senior Whole Health Medicare Advantage |
$196.31
|
| 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 PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
9149083201
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.50
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
9149083201
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$317.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| 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 |
$75.48
|
| 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: Senior Whole Health Medicare Advantage |
$196.31
|
| 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 PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
9149083401
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.50
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
9149083401
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$99.52 |
| Max. Negotiated Rate |
$317.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| 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 |
$99.52
|
| 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: Senior Whole Health Medicare Advantage |
$196.31
|
| 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 PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
9149083701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$198.50 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.50
|
|
|
HC PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
9149083701
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$137.42 |
| Max. Negotiated Rate |
$317.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| 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 |
$147.46
|
| 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: Senior Whole Health Medicare Advantage |
$196.31
|
| 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 PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
9149083301
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90.95
|
| Rate for Payer: Aetna Government |
$90.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$193.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$193.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$86.18
|
| Rate for Payer: Amida Care Medicaid |
$86.18
|
| Rate for Payer: Brighton Health Commercial |
$135.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$86.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.40
|
| Rate for Payer: EmblemHealth Commercial |
$90.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$193.92
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$86.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.49
|
| Rate for Payer: Group Health Inc Commercial |
$90.00
|
| Rate for Payer: Group Health Inc Medicare |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.18
|
| Rate for Payer: Healthfirst Essential Plan |
$193.92
|
| Rate for Payer: Healthfirst QHP |
$140.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$193.92
|
| Rate for Payer: Optum Medicaid |
$0.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.18
|
| Rate for Payer: SOMOS Essential |
$193.92
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$193.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$94.80
|
| Rate for Payer: United Healthcare Medicaid |
$86.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$86.18
|
|
|
HC PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
9009083301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90.95
|
| Rate for Payer: Aetna Government |
$90.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$193.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$193.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$86.18
|
| Rate for Payer: Amida Care Medicaid |
$86.18
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$86.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$193.92
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$86.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.49
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.18
|
| Rate for Payer: Healthfirst Essential Plan |
$193.92
|
| Rate for Payer: Healthfirst QHP |
$140.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$193.92
|
| Rate for Payer: Optum Medicaid |
$0.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.18
|
| Rate for Payer: SOMOS Essential |
$193.92
|
| Rate for Payer: United Healthcare Commercial |
$100.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$193.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$94.80
|
| Rate for Payer: United Healthcare Medicaid |
$86.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$86.18
|
|
|
HC PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
9009083301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
|
|
HC PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
9149083301
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
|
|
HC PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
9009083601
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
|
|
HC PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
9149083601
|
|
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 |
$133.75
|
| Rate for Payer: Aetna Government |
$133.75
|
| 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 |
$206.25
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$134.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$220.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.00
|
| Rate for Payer: EmblemHealth Commercial |
$137.50
|
| 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 |
$137.50
|
| Rate for Payer: Group Health Inc Medicare |
$96.25
|
| 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 PT&/FAMILY W/E&M SRVCS 45 MIN
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
9009083601
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$301.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$133.75
|
| Rate for Payer: Aetna Government |
$133.75
|
| 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 |
$187.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$134.07
|
| 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 |
$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 |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| 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 Commercial |
$125.00
|
| 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 PT&/FAMILY W/E&M SRVCS 45 MIN
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
9149083601
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$137.50 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
|
|
HC PSYCL/NRPSYC TECH 1ST HR
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
9189613801
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$497.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$487.56
|
| Rate for Payer: Aetna Government |
$487.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$430.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$430.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$191.51
|
| Rate for Payer: Amida Care Medicaid |
$191.51
|
| Rate for Payer: Brighton Health Commercial |
$156.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$191.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$487.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$487.56
|
| Rate for Payer: EmblemHealth Commercial |
$487.56
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$430.90
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$191.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$487.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.08
|
| Rate for Payer: Group Health Inc Commercial |
$487.56
|
| Rate for Payer: Group Health Inc Medicare |
$487.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$487.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Healthfirst Essential Plan |
$430.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.43
|
| Rate for Payer: Healthfirst QHP |
$312.16
|
| Rate for Payer: Humana Medicare |
$497.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$430.90
|
| Rate for Payer: Optum Medicaid |
$0.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$487.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: SOMOS Essential |
$430.90
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$430.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$210.66
|
| Rate for Payer: United Healthcare Medicaid |
$191.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$487.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$487.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Wellcare Medicare |
$463.18
|
|
|
HC PSYCL/NRPSYC TECH 1ST HR
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
9189613801
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.50
|
|
|
HC PSYCL/NRPSYC TST AUTO RESULT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
9189614601
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC PSYCL/NRPSYC TST AUTO RESULT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
9189614601
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$34.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC PSYCL/NRPSYC TST PHY/QHP 1ST HR
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
9189613601
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.50
|
|
|
HC PSYCL/NRPSYC TST PHY/QHP 1ST HR
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
9189613601
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$430.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$430.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$430.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$191.51
|
| Rate for Payer: Amida Care Medicaid |
$191.51
|
| Rate for Payer: Brighton Health Commercial |
$156.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$191.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$430.90
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$191.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.08
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Healthfirst Essential Plan |
$430.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$312.16
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$430.90
|
| Rate for Payer: Optum Medicaid |
$0.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: SOMOS Essential |
$430.90
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$430.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$210.66
|
| Rate for Payer: United Healthcare Medicaid |
$191.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$191.51
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC PSYCL/NRPSYC TST PHY/QHP ADD'L HR
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
9189613701
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.50
|
|
