St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Procedure w diag of rehab, aftercare or oth contact w health service

Facility

$52,437.46

Service Code	APR-DRG 8501
Min. Negotiated Rate	$13,223.00
Max. Negotiated Rate	$52,437.46
Rate for Payer: Affinity Essential Plan 1&2	$52,437.46
Rate for Payer: Affinity Essential Plan 3&4	$52,437.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,305.54
Rate for Payer: Amida Care Medicaid	$23,305.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$52,437.46
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,305.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,305.54
Rate for Payer: Fidelis Qualified Health Plan	$27,966.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,305.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,305.54
Rate for Payer: Healthfirst Commercial	$22,015.00
Rate for Payer: Healthfirst Essential Plan	$52,437.46
Rate for Payer: Healthfirst QHP	$13,223.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,305.54
Rate for Payer: SOMOS Essential	$52,437.46
Rate for Payer: United Healthcare Essential Plan 1&2	$52,437.46
Rate for Payer: United Healthcare Essential Plan 3&4	$52,437.46
Rate for Payer: United Healthcare Medicaid	$23,305.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,305.54

Procedure w diag of rehab, aftercare or oth contact w health service

Facility

$88,952.56

Service Code	APR-DRG 8503
Min. Negotiated Rate	$39,534.47
Max. Negotiated Rate	$88,952.56
Rate for Payer: Affinity Essential Plan 1&2	$88,952.56
Rate for Payer: Affinity Essential Plan 3&4	$88,952.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,534.47
Rate for Payer: Amida Care Medicaid	$39,534.47
Rate for Payer: EmblemHealth Essential Plan 1&2	$88,952.56
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,534.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,534.47
Rate for Payer: Fidelis Qualified Health Plan	$47,441.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,534.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,534.47
Rate for Payer: Healthfirst Commercial	$66,679.00
Rate for Payer: Healthfirst Essential Plan	$88,952.56
Rate for Payer: Healthfirst QHP	$48,086.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,534.47
Rate for Payer: SOMOS Essential	$88,952.56
Rate for Payer: United Healthcare Essential Plan 1&2	$88,952.56
Rate for Payer: United Healthcare Essential Plan 3&4	$88,952.56
Rate for Payer: United Healthcare Medicaid	$39,534.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,534.47

Procedure w diag of rehab, aftercare or oth contact w health service

Facility

$166,150.96

Service Code	APR-DRG 8504
Min. Negotiated Rate	$73,844.87
Max. Negotiated Rate	$166,150.96
Rate for Payer: Affinity Essential Plan 1&2	$166,150.96
Rate for Payer: Affinity Essential Plan 3&4	$166,150.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$73,844.87
Rate for Payer: Amida Care Medicaid	$73,844.87
Rate for Payer: EmblemHealth Essential Plan 1&2	$166,150.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$73,844.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$73,844.87
Rate for Payer: Fidelis Qualified Health Plan	$88,613.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$73,844.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73,844.87
Rate for Payer: Healthfirst Commercial	$116,985.00
Rate for Payer: Healthfirst Essential Plan	$166,150.96
Rate for Payer: Healthfirst QHP	$113,284.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73,844.87
Rate for Payer: SOMOS Essential	$166,150.96
Rate for Payer: United Healthcare Essential Plan 1&2	$166,150.96
Rate for Payer: United Healthcare Essential Plan 3&4	$166,150.96
Rate for Payer: United Healthcare Medicaid	$73,844.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$73,844.87

PROCHLORPERAZINE 25 MG RE SUPP

Facility

$12.58

Service Code	NDC 0574722612
Hospital Charge Code	0574722612
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.29
Rate for Payer: Aetna Government	$6.29
Rate for Payer: Brighton Health Commercial	$9.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.56
Rate for Payer: EmblemHealth Commercial	$6.29
Rate for Payer: Group Health Inc Commercial	$6.29
Rate for Payer: Group Health Inc Medicare	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.29
Rate for Payer: Hamaspik Choice Inc Medicare	$6.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.18

PROCHLORPERAZINE 25 MG RE SUPP

Facility

$12.26

Service Code	NDC 0713013506
Hospital Charge Code	0713013506
Hospital Revenue Code	250
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$9.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.13
Rate for Payer: Aetna Government	$6.13
Rate for Payer: Brighton Health Commercial	$9.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.34
Rate for Payer: EmblemHealth Commercial	$6.13
Rate for Payer: Group Health Inc Commercial	$6.13
Rate for Payer: Group Health Inc Medicare	$4.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.13
Rate for Payer: Hamaspik Choice Inc Medicare	$6.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.97

PROCHLORPERAZINE 25 MG RE SUPP

Facility

$12.26

Service Code	NDC 0713013512
Hospital Charge Code	0713013512
Hospital Revenue Code	250
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.13

PROCHLORPERAZINE 25 MG RE SUPP

Facility

$12.26

Service Code	NDC 0713013512
Hospital Charge Code	0713013512
Hospital Revenue Code	250
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$9.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.13
Rate for Payer: Aetna Government	$6.13
Rate for Payer: Brighton Health Commercial	$9.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.34
Rate for Payer: EmblemHealth Commercial	$6.13
Rate for Payer: Group Health Inc Commercial	$6.13
Rate for Payer: Group Health Inc Medicare	$4.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.13
Rate for Payer: Hamaspik Choice Inc Medicare	$6.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.97

PROCHLORPERAZINE 25 MG RE SUPP

Facility

$12.26

Service Code	NDC 0713013506
Hospital Charge Code	0713013506
Hospital Revenue Code	250
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.13

PROCHLORPERAZINE 25 MG RE SUPP

Facility

$12.58

Service Code	NDC 0574722612
Hospital Charge Code	0574722612
Hospital Revenue Code	250
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$6.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.29

PROCHLORPERAZINE MALEATE 10 MG PO TABS

Facility

$0.89

Service Code	HCPCS Q0164
Hospital Charge Code	5974611506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

PROCHLORPERAZINE MALEATE 10 MG PO TABS

Facility

$0.89

Service Code	HCPCS Q0164
Hospital Charge Code	5974611506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

PROCHLORPERAZINE MALEATE 5 MG PO TABS

Facility

$0.59

Service Code	HCPCS Q0164
Hospital Charge Code	5974611306
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

PROCHLORPERAZINE MALEATE 5 MG PO TABS

Facility

$0.59

Service Code	HCPCS Q0164
Hospital Charge Code	5974611306
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

PROCHLORPERAZINE MALEATE 5 MG PO TABS

Facility

$1.52

Service Code	HCPCS Q0164
Hospital Charge Code	0904738106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$1.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.03
Rate for Payer: EmblemHealth Commercial	$0.76
Rate for Payer: Group Health Inc Commercial	$0.76
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76
Rate for Payer: Hamaspik Choice Inc Medicare	$0.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.99

PROCHLORPERAZINE MALEATE 5 MG PO TABS

Facility

$1.52

Service Code	HCPCS Q0164
Hospital Charge Code	0904738106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.76

PR OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE

Professional

Both

$2,765.42

Service Code	HCPCS 65780
Min. Negotiated Rate	$466.12
Max. Negotiated Rate	$1,498.25
Rate for Payer: Cash Price	$673.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$665.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$599.30
Rate for Payer: Fidelis Essential Plan Aliesa	$599.30
Rate for Payer: Fidelis Essential Plan QHP	$632.60
Rate for Payer: Fidelis Medicare Advantage	$665.89
Rate for Payer: Fidelis Qualified Health Plan	$632.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$665.89
Rate for Payer: Hamaspik Choice Inc Medicare	$665.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$499.42
Rate for Payer: Healthfirst Commercial	$665.89
Rate for Payer: Healthfirst Essential Plan	$1,498.25
Rate for Payer: Healthfirst Medicare Advantage	$632.60
Rate for Payer: Healthfirst QHP	$665.89
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$466.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$665.89
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$566.01
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$466.12
Rate for Payer: Senior Whole Health Medicare Advantage	$665.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$499.42
Rate for Payer: SOMOS Essential	$499.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$665.89

PR OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT

Professional

Both

$5,442.64

Service Code	HCPCS 65781
Min. Negotiated Rate	$1,036.32
Max. Negotiated Rate	$3,331.03
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,480.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,332.41
Rate for Payer: Fidelis Essential Plan Aliesa	$1,332.41
Rate for Payer: Fidelis Essential Plan QHP	$1,406.44
Rate for Payer: Fidelis Medicare Advantage	$1,480.46
Rate for Payer: Fidelis Qualified Health Plan	$1,406.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,480.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1,480.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,110.35
Rate for Payer: Healthfirst Commercial	$1,480.46
Rate for Payer: Healthfirst Essential Plan	$3,331.03
Rate for Payer: Healthfirst Medicare Advantage	$1,406.44
Rate for Payer: Healthfirst QHP	$1,480.46
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1,036.32
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,480.46
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1,258.39
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1,036.32
Rate for Payer: Senior Whole Health Medicare Advantage	$1,480.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,110.35
Rate for Payer: SOMOS Essential	$1,110.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,480.46

PR OCULAR VEMP TESTING W/I&R

Professional

Both

$171.50

Service Code	HCPCS 92518
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$105.12
Rate for Payer: Amida Care Medicaid	$49.65
Rate for Payer: Cash Price	$47.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.05
Rate for Payer: Fidelis Essential Plan Aliesa	$42.05
Rate for Payer: Fidelis Essential Plan QHP	$44.38
Rate for Payer: Fidelis Medicare Advantage	$46.72
Rate for Payer: Fidelis Qualified Health Plan	$44.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.72
Rate for Payer: Hamaspik Choice Inc Medicare	$46.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.04
Rate for Payer: Healthfirst Commercial	$46.72
Rate for Payer: Healthfirst Essential Plan	$105.12
Rate for Payer: Healthfirst Medicare Advantage	$44.38
Rate for Payer: Healthfirst QHP	$46.72
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$32.70
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$46.72
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$39.71
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$32.70
Rate for Payer: Senior Whole Health Medicare Advantage	$46.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.04
Rate for Payer: SOMOS Essential	$35.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.72

PR OFF BASE OPIOID TX, 60 M

Professional

Both

$1,200.78

Service Code	HCPCS G2087
Min. Negotiated Rate	$295.86
Max. Negotiated Rate	$950.96
Rate for Payer: Cash Price	$431.69
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$422.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$380.38
Rate for Payer: Fidelis Essential Plan Aliesa	$380.38
Rate for Payer: Fidelis Essential Plan QHP	$401.52
Rate for Payer: Fidelis Medicare Advantage	$422.65
Rate for Payer: Fidelis Qualified Health Plan	$401.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$422.65
Rate for Payer: Hamaspik Choice Inc Medicare	$422.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$316.99
Rate for Payer: Healthfirst Commercial	$422.65
Rate for Payer: Healthfirst Essential Plan	$950.96
Rate for Payer: Healthfirst Medicare Advantage	$401.52
Rate for Payer: Healthfirst QHP	$422.65
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$295.86
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$422.65
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$359.25
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$295.86
Rate for Payer: Senior Whole Health Medicare Advantage	$422.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$316.99
Rate for Payer: SOMOS Essential	$316.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$422.65

PR OFF BASE OPIOID TX 70MIN

Professional

Both

$1,108.31

Service Code	HCPCS G2086
Min. Negotiated Rate	$315.70
Max. Negotiated Rate	$1,014.75
Rate for Payer: Cash Price	$446.97
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$451.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$405.90
Rate for Payer: Fidelis Essential Plan Aliesa	$405.90
Rate for Payer: Fidelis Essential Plan QHP	$428.45
Rate for Payer: Fidelis Medicare Advantage	$451.00
Rate for Payer: Fidelis Qualified Health Plan	$428.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$451.00
Rate for Payer: Hamaspik Choice Inc Medicare	$451.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$338.25
Rate for Payer: Healthfirst Commercial	$451.00
Rate for Payer: Healthfirst Essential Plan	$1,014.75
Rate for Payer: Healthfirst Medicare Advantage	$428.45
Rate for Payer: Healthfirst QHP	$451.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$315.70
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$451.00
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$383.35
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$315.70
Rate for Payer: Senior Whole Health Medicare Advantage	$451.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$338.25
Rate for Payer: SOMOS Essential	$338.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$451.00

PR OFF BASE OPIOID TX, ADD30

Professional

Both

$139.51

Service Code	HCPCS G2088
Min. Negotiated Rate	$28.29
Max. Negotiated Rate	$90.94
Rate for Payer: Cash Price	$42.33
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$40.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36.38
Rate for Payer: Fidelis Essential Plan Aliesa	$36.38
Rate for Payer: Fidelis Essential Plan QHP	$38.40
Rate for Payer: Fidelis Medicare Advantage	$40.42
Rate for Payer: Fidelis Qualified Health Plan	$38.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.42
Rate for Payer: Hamaspik Choice Inc Medicare	$40.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.32
Rate for Payer: Healthfirst Commercial	$40.42
Rate for Payer: Healthfirst Essential Plan	$90.94
Rate for Payer: Healthfirst Medicare Advantage	$38.40
Rate for Payer: Healthfirst QHP	$40.42
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$28.29
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$40.42
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$34.36
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$28.29
Rate for Payer: Senior Whole Health Medicare Advantage	$40.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30.32
Rate for Payer: SOMOS Essential	$30.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.42

PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES

Professional

Both

$492.75

Service Code	HCPCS 99245
Min. Negotiated Rate	$125.92
Max. Negotiated Rate	$125.92
Rate for Payer: Amida Care Medicaid	$125.92

PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES

Professional

Both

$273.00

Service Code	HCPCS 99243
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$48.30
Rate for Payer: Amida Care Medicaid	$48.30

PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES

Professional

Both

$404.25

Service Code	HCPCS 99244
Min. Negotiated Rate	$75.62
Max. Negotiated Rate	$75.62
Rate for Payer: Amida Care Medicaid	$75.62

PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES

Professional

Both

$197.25

Service Code	HCPCS 99242
Min. Negotiated Rate	$34.64
Max. Negotiated Rate	$34.64
Rate for Payer: Amida Care Medicaid	$34.64

Know your out-of-pocket cost for care.

All Charges