|
FRENECTOMY - LINGUAL
|
Facility
|
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
40019586
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,065.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,234.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,234.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,234.52
|
| Rate for Payer: Brighton Health Commercial |
$3,065.12
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Humana Medicare |
$1,798.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
FRENECTOMY - LINGUAL
|
Facility
|
IP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
40019586
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
|
Frenoplasty (surgical revision of frenum, eg, with Z-plasty)
|
Facility
|
OP
|
$3,797.69
|
|
|
Service Code
|
CPT 41520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,797.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,606.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,606.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,606.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Humana Medicare |
$3,797.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
FRENULECTOMY (FRENECTOMY/FRENOTOM
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS D7960
|
| Hospital Charge Code |
42302120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$261.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$237.50
|
| Rate for Payer: Aetna Government |
$237.50
|
| Rate for Payer: Brighton Health Commercial |
$356.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$237.50
|
| Rate for Payer: Group Health Inc Medicare |
$166.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.50
|
|
|
FRESH FROZEN PLASMA
|
Facility
|
OP
|
$102.50
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
40701187
|
|
Hospital Revenue Code
|
383
|
| Min. Negotiated Rate |
$51.25 |
| Max. Negotiated Rate |
$98.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.05
|
| Rate for Payer: Aetna Government |
$97.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.94
|
| Rate for Payer: Brighton Health Commercial |
$97.05
|
| Rate for Payer: Cash Price |
$97.05
|
| Rate for Payer: Cash Price |
$97.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$97.05
|
| Rate for Payer: EmblemHealth Commercial |
$97.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.37
|
| Rate for Payer: Group Health Inc Commercial |
$97.05
|
| Rate for Payer: Group Health Inc Medicare |
$97.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.49
|
| Rate for Payer: Healthfirst QHP |
$97.05
|
| Rate for Payer: Humana Medicare |
$98.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.05
|
| Rate for Payer: United Healthcare Commercial |
$51.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$77.64
|
| Rate for Payer: Wellcare Medicare |
$87.34
|
|
|
FRESH FROZEN PLASMA
|
Facility
|
IP
|
$102.50
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
40701187
|
|
Hospital Revenue Code
|
383
|
| Rate for Payer: Cash Price |
$97.05
|
|
|
FRP-LOCAL LESION
|
Facility
|
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 67208
|
| Hospital Charge Code |
42101018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$235.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$235.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$235.82
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| 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 |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.35
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: Humana Medicare |
$343.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
FRP-LOCAL LESION
|
Facility
|
IP
|
$819.25
|
|
|
Service Code
|
HCPCS 67208
|
| Hospital Charge Code |
42101018
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$336.88
|
|
|
FRUCTOSAMINE_
|
Facility
|
IP
|
$41.90
|
|
|
Service Code
|
HCPCS 82985
|
| Hospital Charge Code |
40609079
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.76
|
|
|
FRUCTOSAMINE_
|
Facility
|
OP
|
$41.90
|
|
|
Service Code
|
HCPCS 82985
|
| Hospital Charge Code |
40609079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$31.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.76
|
| Rate for Payer: Aetna Government |
$16.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.73
|
| Rate for Payer: Brighton Health Commercial |
$31.42
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.76
|
| Rate for Payer: EmblemHealth Commercial |
$16.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.92
|
| Rate for Payer: Group Health Inc Commercial |
$16.76
|
| Rate for Payer: Group Health Inc Medicare |
$16.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.76
|
| Rate for Payer: Healthfirst QHP |
$16.76
|
| Rate for Payer: Humana Medicare |
$17.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.76
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.41
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
|
|
FSH, SERUM
|
Facility
|
OP
|
$46.45
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
40609080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.58
|
| Rate for Payer: Aetna Government |
$18.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.01
|
| Rate for Payer: Brighton Health Commercial |
$34.84
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.58
|
| Rate for Payer: EmblemHealth Commercial |
$18.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.54
|
| Rate for Payer: Group Health Inc Commercial |
$18.58
|
| Rate for Payer: Group Health Inc Medicare |
$18.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.58
|
| Rate for Payer: Healthfirst QHP |
$18.58
|
| Rate for Payer: Humana Medicare |
$18.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$23.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.86
|
| Rate for Payer: Wellcare Medicare |
$16.72
|
|
|
FSH, SERUM
|
Facility
|
IP
|
$46.45
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
40609080
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$18.58
|
|
|
FTA
|
Facility
|
IP
|
$33.10
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
40607163
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.24
|
|
|
FTA
|
Facility
|
OP
|
$33.10
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
40607163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.82
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.59
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
FT ENVIRONMENTAL MANAGEMENT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 90882
|
| Hospital Charge Code |
30303102
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$2,030.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.44
|
| Rate for Payer: Aetna Government |
$70.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.30
|
| Rate for Payer: Amida Care Medicaid |
$20.30
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,030.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.32
|
| 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 |
$20.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.30
|
| Rate for Payer: Healthfirst Essential Plan |
$45.68
|
| Rate for Payer: Healthfirst QHP |
$20.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.30
|
| Rate for Payer: SOMOS Essential |
$45.68
|
| Rate for Payer: United Healthcare Commercial |
$100.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.33
|
| Rate for Payer: United Healthcare Medicaid |
$20.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.30
|
|
|
FT FAMILY THERAPY WITH PATIENT
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
30303105
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$147.50 |
| Max. Negotiated Rate |
$26,116.00 |
| 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 |
$587.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$587.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$261.16
|
| Rate for Payer: Amida Care Medicaid |
$261.16
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$263.54
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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 |
$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 CHP/HARP/Medicaid |
$26,116.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$261.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$261.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.22
|
| 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 |
$261.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.16
|
| Rate for Payer: Healthfirst Essential Plan |
$587.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$261.16
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$592.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$592.96
|
| Rate for Payer: Optum Medicaid |
$263.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$261.16
|
| Rate for Payer: SOMOS Essential |
$587.61
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$587.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$287.28
|
| Rate for Payer: United Healthcare Medicaid |
$261.16
|
| 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
|
|
|
FT FAMILY THERAPY WITH PATIENT
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
30303105
|
|
Hospital Revenue Code
|
916
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
FT FAMILY THERAPY W/O PATIENT
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
30303106
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.82
|
| 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: Carelon Behavioral Health Medicare Advantage |
$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
|
|
|
FT FAMILY THERAPY W/O PATIENT
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
30303106
|
|
Hospital Revenue Code
|
916
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
FT GROUP THERAPY NOT MULTI-FAMILY
|
Facility
|
IP
|
$237.88
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
30303104
|
|
Hospital Revenue Code
|
915
|
| Rate for Payer: Cash Price |
$103.08
|
|
|
FT GROUP THERAPY NOT MULTI-FAMILY
|
Facility
|
OP
|
$237.88
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
30303104
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$6,747.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.00
|
| 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: 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 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 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
|
|
|
FT RESULTS EXPLAINED TO FAMILY
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
30303101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.80
|
| Rate for Payer: Aetna Government |
$64.80
|
| Rate for Payer: Brighton Health Commercial |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
F.T.S.G. MOUTH
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013147
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
F.T.S.G. MOUTH
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,904.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,904.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,904.17
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Humana Medicare |
$4,231.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
F.T.S.G. WITH CLOSURE ARMS
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15220
|
| Hospital Charge Code |
40013154
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
