|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]
|
Facility
|
OP
|
$8.71
|
|
|
Service Code
|
NDC 00093317431
|
| Hospital Charge Code |
00093317431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Brighton Health Commercial |
$6.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.92
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.66
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
NDC 59310057922
|
| Hospital Charge Code |
59310057922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.17
|
| Rate for Payer: Aetna Government |
$5.17
|
| Rate for Payer: Brighton Health Commercial |
$7.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.04
|
| Rate for Payer: Group Health Inc Commercial |
$5.17
|
| Rate for Payer: Group Health Inc Medicare |
$3.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.73
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
NDC 00173068224
|
| Hospital Charge Code |
00173068224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.32
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.22
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]
|
Facility
|
OP
|
$6.71
|
|
|
Service Code
|
NDC 00781729685
|
| Hospital Charge Code |
00781729685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Brighton Health Commercial |
$5.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.56
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.36
|
|
|
ALCOHOL AND/O DRUG ASSESS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS H0001
|
| Hospital Charge Code |
30305704
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$18,861.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.45
|
| Rate for Payer: Aetna Government |
$99.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$424.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$424.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$188.61
|
| Rate for Payer: Amida Care Medicaid |
$188.61
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$190.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,861.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.04
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.61
|
| Rate for Payer: Healthfirst Essential Plan |
$424.37
|
| Rate for Payer: Healthfirst QHP |
$188.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$428.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.24
|
| Rate for Payer: Optum Medicaid |
$190.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.61
|
| Rate for Payer: SOMOS Essential |
$424.37
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$424.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$207.47
|
| Rate for Payer: United Healthcare Medicaid |
$188.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$188.61
|
|
|
ALCOHOL AND/OR DRG ASSESS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS H0001
|
| Hospital Charge Code |
30400343
|
|
Hospital Revenue Code
|
900
|
| Max. Negotiated Rate |
$18,861.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.45
|
| Rate for Payer: Aetna Government |
$99.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$424.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$424.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$188.61
|
| Rate for Payer: Amida Care Medicaid |
$188.61
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$190.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,861.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.61
|
| Rate for Payer: Healthfirst Essential Plan |
$424.37
|
| Rate for Payer: Healthfirst QHP |
$188.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$428.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.24
|
| Rate for Payer: Optum Medicaid |
$190.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.61
|
| Rate for Payer: SOMOS Essential |
$424.37
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$424.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$207.47
|
| Rate for Payer: United Healthcare Medicaid |
$188.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$188.61
|
|
|
ALCOHOL AND/OR DRG SC, GRP
|
Facility
|
OP
|
$159.02
|
|
|
Service Code
|
HCPCS H0005
|
| Hospital Charge Code |
30400233
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$127.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.89
|
| Rate for Payer: Aetna Government |
$16.89
|
| Rate for Payer: Brighton Health Commercial |
$119.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$127.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.13
|
| Rate for Payer: Group Health Inc Commercial |
$79.51
|
| Rate for Payer: Group Health Inc Medicare |
$55.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.51
|
| Rate for Payer: United Healthcare Commercial |
$79.51
|
|
|
ALCOHOL AND/OR DRUG PREVENT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS H0028
|
| Hospital Charge Code |
30305705
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
ALCOHOL AND/OR DRUG SERVICES
|
Facility
|
OP
|
$74.09
|
|
|
Service Code
|
HCPCS H0004
|
| Hospital Charge Code |
30300131
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$5,897.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.78
|
| Rate for Payer: Aetna Government |
$10.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$132.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$132.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$58.97
|
| Rate for Payer: Amida Care Medicaid |
$58.97
|
| Rate for Payer: Brighton Health Commercial |
$55.57
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$59.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,897.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.92
|
| Rate for Payer: Group Health Inc Commercial |
$37.04
|
| Rate for Payer: Group Health Inc Medicare |
$25.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.97
|
| Rate for Payer: Healthfirst Essential Plan |
$132.68
|
| Rate for Payer: Healthfirst QHP |
$58.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.90
|
| Rate for Payer: Optum Medicaid |
$59.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.97
|
| Rate for Payer: SOMOS Essential |
$132.68
|
| Rate for Payer: United Healthcare Commercial |
$37.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$132.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64.87
|
| Rate for Payer: United Healthcare Medicaid |
$58.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.97
|
|
|
ALCOHOL AND/OR DRUG SERVICES
|
Facility
|
OP
|
$168.89
|
|
|
Service Code
|
HCPCS H0014
|
| Hospital Charge Code |
30400242
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$17,410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$220.62
|
| Rate for Payer: Aetna Government |
$220.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$391.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$391.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$174.10
|
| Rate for Payer: Amida Care Medicaid |
$174.10
|
| Rate for Payer: Brighton Health Commercial |
$126.67
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$175.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.80
|
| Rate for Payer: Group Health Inc Commercial |
$84.44
|
| Rate for Payer: Group Health Inc Medicare |
$59.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.10
|
| Rate for Payer: Healthfirst Essential Plan |
$391.72
|
| Rate for Payer: Healthfirst QHP |
$174.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.30
|
| Rate for Payer: Optum Medicaid |
$175.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.10
|
| Rate for Payer: SOMOS Essential |
$391.72
|
| Rate for Payer: United Healthcare Commercial |
$84.44
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$391.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$191.51
|
| Rate for Payer: United Healthcare Medicaid |
$174.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$174.10
|
|
|
ALCOHOL AND/OR DRUG SVCES, CASE M
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS H0006
|
| Hospital Charge Code |
30305581
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.53
|
| Rate for Payer: Aetna Government |
$73.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$195.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$195.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$87.05
|
| Rate for Payer: Amida Care Medicaid |
$87.05
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$87.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8,705.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.40
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.05
|
| Rate for Payer: Healthfirst Essential Plan |
$195.86
|
| Rate for Payer: Healthfirst QHP |
$87.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.66
|
| Rate for Payer: Optum Medicaid |
$87.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.05
|
| Rate for Payer: SOMOS Essential |
$195.86
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$195.86
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$95.76
|
| Rate for Payer: United Healthcare Medicaid |
$87.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$87.05
|
|
|
ALCOHOL AND/OR DRUG SVC, GRP
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS H0005
|
| Hospital Charge Code |
30305712
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.89
|
| Rate for Payer: Aetna Government |
$16.89
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
ALCOHOL/DRG FAM/COUPLE COUNSELING
|
Facility
|
OP
|
$281.61
|
|
|
Service Code
|
HCPCS T1006
|
| Hospital Charge Code |
30400236
|
|
Hospital Revenue Code
|
945
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.08
|
| Rate for Payer: Aetna Government |
$28.08
|
| Rate for Payer: Brighton Health Commercial |
$211.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.49
|
| Rate for Payer: Group Health Inc Commercial |
$140.80
|
| Rate for Payer: Group Health Inc Medicare |
$98.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.80
|
| Rate for Payer: Optum Commercial/Medicare |
$239.00
|
|
|
ALCOHOL/DRG METH ADMIN
|
Facility
|
OP
|
$82.54
|
|
|
Service Code
|
HCPCS H0020
|
| Hospital Charge Code |
30400238
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$66.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.64
|
| Rate for Payer: Aetna Government |
$24.64
|
| Rate for Payer: Brighton Health Commercial |
$61.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.13
|
| Rate for Payer: Group Health Inc Commercial |
$41.27
|
| Rate for Payer: Group Health Inc Medicare |
$28.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.27
|
| Rate for Payer: United Healthcare Commercial |
$41.27
|
|
|
ALCOHOL/DRG PROGRAM PER DIEM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS H2036
|
| Hospital Charge Code |
30400249
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$13,850.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$491.49
|
| Rate for Payer: Aetna Government |
$491.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$311.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$311.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$138.50
|
| Rate for Payer: Amida Care Medicaid |
$138.50
|
| Rate for Payer: Brighton Health Commercial |
$222.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$237.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,850.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.42
|
| Rate for Payer: Group Health Inc Commercial |
$148.50
|
| Rate for Payer: Group Health Inc Medicare |
$103.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.50
|
| Rate for Payer: Healthfirst Essential Plan |
$311.62
|
| Rate for Payer: Healthfirst QHP |
$138.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.50
|
| Rate for Payer: SOMOS Essential |
$311.62
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$311.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$152.35
|
| Rate for Payer: United Healthcare Medicaid |
$138.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$138.50
|
|
|
ALCOHOL/DRG SCREENING
|
Facility
|
OP
|
$142.53
|
|
|
Service Code
|
HCPCS H0049
|
| Hospital Charge Code |
30400234
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$114.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$106.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.92
|
| Rate for Payer: Group Health Inc Commercial |
$71.26
|
| Rate for Payer: Group Health Inc Medicare |
$49.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.26
|
| Rate for Payer: United Healthcare Commercial |
$71.26
|
|
|
ALCOHOL/DRG SERVICE 15 MIN
|
Facility
|
OP
|
$142.53
|
|
|
Service Code
|
HCPCS H0050
|
| Hospital Charge Code |
30400235
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$5,897.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.00
|
| Rate for Payer: Aetna Government |
$30.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$132.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$132.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$58.97
|
| Rate for Payer: Amida Care Medicaid |
$58.97
|
| Rate for Payer: Brighton Health Commercial |
$106.90
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$59.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,897.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.92
|
| Rate for Payer: Group Health Inc Commercial |
$71.26
|
| Rate for Payer: Group Health Inc Medicare |
$49.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.97
|
| Rate for Payer: Healthfirst Essential Plan |
$132.68
|
| Rate for Payer: Healthfirst QHP |
$58.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.90
|
| Rate for Payer: Optum Medicaid |
$59.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.97
|
| Rate for Payer: SOMOS Essential |
$132.68
|
| Rate for Payer: United Healthcare Commercial |
$71.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$132.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64.87
|
| Rate for Payer: United Healthcare Medicaid |
$58.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.97
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
|
IP
|
$21,030.13
|
|
|
Service Code
|
MSDRG 894
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$21,030.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,529.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,294.64
|
| Rate for Payer: Aetna Government |
$15,294.64
|
| Rate for Payer: Brighton Health Commercial |
$8,330.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,600.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9,921.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,187.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$14,529.91
|
| Rate for Payer: EmblemHealth Commercial |
$795.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,294.64
|
| Rate for Payer: Group Health Inc Commercial |
$15,294.64
|
| Rate for Payer: Group Health Inc Medicare |
$15,294.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,294.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,112.01
|
| Rate for Payer: Humana Medicare |
$21,030.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,294.64
|
| Rate for Payer: United Healthcare Commercial |
$11,425.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,294.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,294.64
|
| Rate for Payer: Wellcare Medicare |
$14,529.91
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
|
IP
|
$43,979.98
|
|
|
Service Code
|
MSDRG 896
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$43,979.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,529.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,985.44
|
| Rate for Payer: Aetna Government |
$31,985.44
|
| Rate for Payer: Brighton Health Commercial |
$25,782.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,625.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,706.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,339.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,386.17
|
| Rate for Payer: EmblemHealth Commercial |
$795.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,985.44
|
| Rate for Payer: Group Health Inc Commercial |
$31,985.44
|
| Rate for Payer: Group Health Inc Medicare |
$31,985.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,985.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,873.23
|
| Rate for Payer: Humana Medicare |
$43,979.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,985.44
|
| Rate for Payer: United Healthcare Commercial |
$35,361.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,985.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,985.44
|
| Rate for Payer: Wellcare Medicare |
$30,386.17
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
|
IP
|
$26,390.07
|
|
|
Service Code
|
MSDRG 897
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$26,390.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,529.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,192.78
|
| Rate for Payer: Aetna Government |
$19,192.78
|
| Rate for Payer: Brighton Health Commercial |
$12,406.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,576.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,775.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,193.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,233.14
|
| Rate for Payer: EmblemHealth Commercial |
$795.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,192.78
|
| Rate for Payer: Group Health Inc Commercial |
$19,192.78
|
| Rate for Payer: Group Health Inc Medicare |
$19,192.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,192.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,924.64
|
| Rate for Payer: Humana Medicare |
$26,390.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,192.78
|
| Rate for Payer: United Healthcare Commercial |
$17,015.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,192.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,192.78
|
| Rate for Payer: Wellcare Medicare |
$18,233.14
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
|
IP
|
$40,751.81
|
|
|
Service Code
|
MSDRG 895
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$40,751.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,529.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,637.68
|
| Rate for Payer: Aetna Government |
$29,637.68
|
| Rate for Payer: Brighton Health Commercial |
$23,327.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,230.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,782.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,927.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,155.80
|
| Rate for Payer: EmblemHealth Commercial |
$795.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,637.68
|
| Rate for Payer: Group Health Inc Commercial |
$29,637.68
|
| Rate for Payer: Group Health Inc Medicare |
$29,637.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,637.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,781.52
|
| Rate for Payer: Humana Medicare |
$40,751.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,637.68
|
| Rate for Payer: United Healthcare Commercial |
$31,994.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,637.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,637.68
|
| Rate for Payer: Wellcare Medicare |
$28,155.80
|
|
|
ALCOHOL/DRUG ABUSE SVC, NOC
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS H0047
|
| Hospital Charge Code |
30305713
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.00
|
| Rate for Payer: Aetna Government |
$206.00
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
ALCOHOL/DRUG ALTERNATIVES
|
Facility
|
OP
|
$57.70
|
|
|
Service Code
|
HCPCS H0049
|
| Hospital Charge Code |
30301285
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$46.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$43.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.24
|
| Rate for Payer: Group Health Inc Commercial |
$28.85
|
| Rate for Payer: Group Health Inc Medicare |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.85
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
|
|
ALCOHOL/DRUG SCREENING
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS H0049
|
| Hospital Charge Code |
30305711
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
ALCOHOL/DRUG SERVICE 15 MIN
|
Facility
|
OP
|
$57.70
|
|
|
Service Code
|
HCPCS H0050
|
| Hospital Charge Code |
30301286
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$5,897.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.00
|
| Rate for Payer: Aetna Government |
$30.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$132.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$132.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$58.97
|
| Rate for Payer: Amida Care Medicaid |
$58.97
|
| Rate for Payer: Brighton Health Commercial |
$43.28
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$59.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,897.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.92
|
| Rate for Payer: Group Health Inc Commercial |
$28.85
|
| Rate for Payer: Group Health Inc Medicare |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.97
|
| Rate for Payer: Healthfirst Essential Plan |
$132.68
|
| Rate for Payer: Healthfirst QHP |
$58.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.90
|
| Rate for Payer: Optum Medicaid |
$59.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.97
|
| Rate for Payer: SOMOS Essential |
$132.68
|
| Rate for Payer: United Healthcare Commercial |
$28.85
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$132.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64.87
|
| Rate for Payer: United Healthcare Medicaid |
$58.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.97
|
|
