|
ALCOHOL/DRUG SVC, 15 MIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS H0050
|
| Hospital Charge Code |
30305714
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$5,897.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| 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 |
$15.00
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$59.51
|
| 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 |
$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 |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| 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 |
$10.00
|
| 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 ISOPROPYL 16OZ
|
Facility
|
OP
|
$2.10
|
|
| Hospital Charge Code |
40201023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
|
|
ALCOHOL &/OR DRUG INTER-PLANNED
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS H0022
|
| Hospital Charge Code |
30305585
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$23.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.03
|
| Rate for Payer: Aetna Government |
$23.03
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| 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 |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
|
|
ALCOHOL &/OR DRUG INTERVEN - OP
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS H0007
|
| Hospital Charge Code |
30305583
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.25
|
| Rate for Payer: Aetna Government |
$14.25
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| 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 |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
|
|
ALCOHOL REHAB. CLINIC (GROUP)
|
Facility
|
IP
|
$237.88
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
30310003
|
|
Hospital Revenue Code
|
945
|
| Rate for Payer: Cash Price |
$103.08
|
|
|
ALCOHOL REHAB. CLINIC (GROUP)
|
Facility
|
OP
|
$237.88
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
30310003
|
|
Hospital Revenue Code
|
945
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$6,747.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.08
|
| Rate for Payer: Aetna Government |
$103.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$151.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$151.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.47
|
| Rate for Payer: Amida Care Medicaid |
$67.47
|
| Rate for Payer: Brighton Health Commercial |
$178.41
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$68.09
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$103.08
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,747.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.84
|
| Rate for Payer: Group Health Inc Commercial |
$103.08
|
| Rate for Payer: Group Health Inc Medicare |
$103.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.47
|
| Rate for Payer: Healthfirst Essential Plan |
$151.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.62
|
| Rate for Payer: Healthfirst QHP |
$67.47
|
| Rate for Payer: Humana Medicare |
$105.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.20
|
| Rate for Payer: Optum Commercial/Medicare |
$239.00
|
| Rate for Payer: Optum Medicaid |
$68.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.47
|
| Rate for Payer: SOMOS Essential |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$74.22
|
| Rate for Payer: United Healthcare Medicaid |
$67.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.46
|
| Rate for Payer: Wellcare Medicare |
$97.93
|
|
|
ALCOHOL REHAB. INITIAL CLINIC
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
30310002
|
|
Hospital Revenue Code
|
900
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
ALCOHOL REHAB. INITIAL CLINIC
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
30310002
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Commercial |
$198.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
ALCOHOL/SBS ASSESS 30 MIN
|
Facility
|
IP
|
$237.88
|
|
|
Service Code
|
HCPCS G0397
|
| Hospital Charge Code |
30400231
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
ALCOHOL/SBS ASSESS 30 MIN
|
Facility
|
OP
|
$237.88
|
|
|
Service Code
|
HCPCS G0397
|
| Hospital Charge Code |
30400231
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$17,410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| 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 |
$178.41
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$175.69
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| 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 Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.80
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.10
|
| Rate for Payer: Healthfirst Essential Plan |
$391.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$174.10
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.38
|
| 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: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.10
|
| Rate for Payer: SOMOS Essential |
$391.72
|
| Rate for Payer: United Healthcare Commercial |
$118.94
|
| 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: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
ALCOHOL/SBS INTER 15-30 MIN
|
Facility
|
IP
|
$82.75
|
|
|
Service Code
|
HCPCS G0396
|
| Hospital Charge Code |
30400230
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$33.18
|
|
|
ALCOHOL/SBS INTER 15-30 MIN
|
Facility
|
OP
|
$82.75
|
|
|
Service Code
|
HCPCS G0396
|
| Hospital Charge Code |
30400230
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$13,057.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$293.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$293.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$130.57
|
| Rate for Payer: Amida Care Medicaid |
$130.57
|
| Rate for Payer: Brighton Health Commercial |
$62.06
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$131.76
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: EmblemHealth Commercial |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,057.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.10
|
| Rate for Payer: Group Health Inc Commercial |
$33.18
|
| Rate for Payer: Group Health Inc Medicare |
$33.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.57
|
| Rate for Payer: Healthfirst Essential Plan |
$293.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$130.57
|
| Rate for Payer: Humana Medicare |
$33.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.46
|
| Rate for Payer: Optum Medicaid |
$131.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.57
|
| Rate for Payer: SOMOS Essential |
$293.78
|
| Rate for Payer: United Healthcare Commercial |
$41.38
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$293.78
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$143.63
|
| Rate for Payer: United Healthcare Medicaid |
$130.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
ALCOHOL/SBSTANCE INTER PT 25 MIN
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
30400200
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
ALCOHOL/SBSTANCE INTER PT 25 MIN
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
30400200
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
ALCOHOL/SBSTANCE INTER PT 45 MIN
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30400201
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
ALCOHOL/SBSTANCE INTER PT 45 MIN
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30400201
|
|
Hospital Revenue Code
|
914
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
ALCOHOL/SBSTANCE INTER PT 45 MIN
|
Facility
|
IP
|
$358.63
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30400203
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
ALCOHOL/SBSTANCE INTER PT 45 MIN
|
Facility
|
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
30400203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.07
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| 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 |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
ALCOHOL/SUBS ASSESS > 30 MIN
|
Facility
|
OP
|
$237.88
|
|
|
Service Code
|
HCPCS G0397
|
| Hospital Charge Code |
30305703
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$17,410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| 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 |
$178.41
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$175.69
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| 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 Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.80
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.10
|
| Rate for Payer: Healthfirst Essential Plan |
$391.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$174.10
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.38
|
| 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: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.10
|
| Rate for Payer: SOMOS Essential |
$391.72
|
| Rate for Payer: United Healthcare Commercial |
$118.94
|
| 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: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
ALCOHOL/SUBS ASSESS > 30 MIN
|
Facility
|
IP
|
$237.88
|
|
|
Service Code
|
HCPCS G0397
|
| Hospital Charge Code |
30305703
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
ALCOHOL/SUBS INTER 15-30 MIN
|
Facility
|
IP
|
$82.75
|
|
|
Service Code
|
HCPCS G0396
|
| Hospital Charge Code |
30305702
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$33.18
|
|
|
ALCOHOL/SUBS INTER 15-30 MIN
|
Facility
|
OP
|
$82.75
|
|
|
Service Code
|
HCPCS G0396
|
| Hospital Charge Code |
30305702
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$13,057.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$293.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$293.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$130.57
|
| Rate for Payer: Amida Care Medicaid |
$130.57
|
| Rate for Payer: Brighton Health Commercial |
$62.06
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$131.76
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: EmblemHealth Commercial |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,057.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.10
|
| Rate for Payer: Group Health Inc Commercial |
$33.18
|
| Rate for Payer: Group Health Inc Medicare |
$33.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.57
|
| Rate for Payer: Healthfirst Essential Plan |
$293.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$130.57
|
| Rate for Payer: Humana Medicare |
$33.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.46
|
| Rate for Payer: Optum Medicaid |
$131.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.57
|
| Rate for Payer: SOMOS Essential |
$293.78
|
| Rate for Payer: United Healthcare Commercial |
$41.38
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$293.78
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$143.63
|
| Rate for Payer: United Healthcare Medicaid |
$130.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
ALCOHOL SUBSTANCE ABUSE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS T1012
|
| Hospital Charge Code |
30306405
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.22
|
| Rate for Payer: Aetna Government |
$11.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
ALCOHOL-U
|
Facility
|
OP
|
$155.35
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
40602434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$124.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$116.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.64
|
| Rate for Payer: Group Health Inc Commercial |
$77.68
|
| Rate for Payer: Group Health Inc Medicare |
$54.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.68
|
| Rate for Payer: United Healthcare Commercial |
$31.48
|
|
|
ALCON 11.0D
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
40208184
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$175.00
|
| Rate for Payer: Aetna Government |
$175.00
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
