St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ALCOHOL AND/OR DRUG PREVENTN ID & REF SVCS

Facility

$20.00

Service Code	CPT H0028
Hospital Charge Code	900H002801
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: EmblemHealth Commercial	$10.00
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

HC ALCOHOL AND/OR DRUG PREVENTN ID & REF SVCS

Facility

$20.00

Service Code	CPT H0028
Hospital Charge Code	900H002801
Hospital Revenue Code	900
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00

HC ALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF ALCOHOL AND/OR DRUGS

Facility

$485.00

Service Code	CPT H0003
Hospital Charge Code	900H000301
Hospital Revenue Code	900
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$388.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$363.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$388.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$329.80
Rate for Payer: EmblemHealth Commercial	$242.50
Rate for Payer: Group Health Inc Commercial	$242.50
Rate for Payer: Group Health Inc Medicare	$169.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.50
Rate for Payer: Hamaspik Choice Inc Medicare	$242.50
Rate for Payer: United Healthcare Commercial	$242.50

HC ALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF ALCOHOL AND/OR DRUGS

Facility

$485.00

Service Code	CPT H0003
Hospital Charge Code	900H000301
Hospital Revenue Code	900
Min. Negotiated Rate	$242.50
Max. Negotiated Rate	$242.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.50

HC ALCOHOL AND/OR DRUG SERVICES

Facility

$74.00

Service Code	CPT H0004
Hospital Charge Code	940H000401
Hospital Revenue Code	940
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$145.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.78
Rate for Payer: Aetna Government	$10.78
Rate for Payer: Affinity Essential Plan 1&2	$145.96
Rate for Payer: Affinity Essential Plan 3&4	$145.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$64.87
Rate for Payer: Amida Care Medicaid	$64.87
Rate for Payer: Brighton Health Commercial	$55.50
Rate for Payer: Carelon Behavioral Health HARP/QHP	$64.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.32
Rate for Payer: EmblemHealth Commercial	$37.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$145.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$64.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64.87
Rate for Payer: Fidelis Essential Plan Aliesa	$145.96
Rate for Payer: Fidelis Essential Plan QHP	$145.96
Rate for Payer: Fidelis Qualified Health Plan	$68.11
Rate for Payer: Group Health Inc Commercial	$37.00
Rate for Payer: Group Health Inc Medicare	$25.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.87
Rate for Payer: Hamaspik Choice Inc Medicare	$64.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64.87
Rate for Payer: Healthfirst Essential Plan	$145.96
Rate for Payer: Healthfirst QHP	$105.74
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$64.80
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$145.80
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$145.80
Rate for Payer: Optum Medicaid	$0.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.87
Rate for Payer: SOMOS Essential	$145.96
Rate for Payer: United Healthcare Commercial	$37.00
Rate for Payer: United Healthcare Essential Plan 1&2	$145.96
Rate for Payer: United Healthcare Essential Plan 3&4	$71.36
Rate for Payer: United Healthcare Medicaid	$64.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.87

HC ALCOHOL AND/OR DRUG SERVICES

Facility

$74.00

Service Code	CPT H0004
Hospital Charge Code	940H000401
Hospital Revenue Code	940
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00

HC ALCOHOL AND/OR DRUG SERVICES, AMBULATORY DETOX

Facility

$168.00

Service Code	CPT H0014
Hospital Charge Code	900H001401
Hospital Revenue Code	900
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$430.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$220.62
Rate for Payer: Aetna Government	$220.62
Rate for Payer: Affinity Essential Plan 1&2	$430.90
Rate for Payer: Affinity Essential Plan 3&4	$430.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$191.51
Rate for Payer: Amida Care Medicaid	$191.51
Rate for Payer: Brighton Health Commercial	$126.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$191.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$134.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.24
Rate for Payer: EmblemHealth Commercial	$84.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$430.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$191.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$191.51
Rate for Payer: Fidelis Essential Plan Aliesa	$430.90
Rate for Payer: Fidelis Essential Plan QHP	$430.90
Rate for Payer: Fidelis Qualified Health Plan	$201.08
Rate for Payer: Group Health Inc Commercial	$84.00
Rate for Payer: Group Health Inc Medicare	$58.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.51
Rate for Payer: Hamaspik Choice Inc Medicare	$191.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.51
Rate for Payer: Healthfirst Essential Plan	$430.90
Rate for Payer: Healthfirst QHP	$312.16
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$191.51
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$430.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$430.90
Rate for Payer: Optum Medicaid	$0.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.51
Rate for Payer: SOMOS Essential	$430.90
Rate for Payer: United Healthcare Commercial	$84.00
Rate for Payer: United Healthcare Essential Plan 1&2	$430.90
Rate for Payer: United Healthcare Essential Plan 3&4	$210.66
Rate for Payer: United Healthcare Medicaid	$191.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$191.51

HC ALCOHOL AND/OR DRUG SERVICES, AMBULATORY DETOX

Facility

$168.00

Service Code	CPT H0014
Hospital Charge Code	900H001401
Hospital Revenue Code	900
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.00

HC ALCOHOL AND/OR DRUG SVCS, CASE MGMT

Facility

$10.00

Service Code	CPT H0006
Hospital Charge Code	900H000601
Hospital Revenue Code	900
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC ALCOHOL AND/OR DRUG SVCS, CASE MGMT

Facility

$10.00

Service Code	CPT H0006
Hospital Charge Code	900H000601
Hospital Revenue Code	900
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$215.47
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	$215.47
Rate for Payer: Affinity Essential Plan 3&4	$215.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$95.77
Rate for Payer: Amida Care Medicaid	$95.77
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Carelon Behavioral Health HARP/QHP	$95.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$215.47
Rate for Payer: EmblemHealth Essential Plan 3&4	$95.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$95.77
Rate for Payer: Fidelis Essential Plan Aliesa	$215.47
Rate for Payer: Fidelis Essential Plan QHP	$215.47
Rate for Payer: Fidelis Qualified Health Plan	$100.55
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	$95.77
Rate for Payer: Hamaspik Choice Inc Medicare	$95.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$95.77
Rate for Payer: Healthfirst Essential Plan	$215.47
Rate for Payer: Healthfirst QHP	$156.10
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$95.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$215.47
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$215.47
Rate for Payer: Optum Medicaid	$0.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.77
Rate for Payer: SOMOS Essential	$215.47
Rate for Payer: United Healthcare Commercial	$5.00
Rate for Payer: United Healthcare Essential Plan 1&2	$215.47
Rate for Payer: United Healthcare Essential Plan 3&4	$105.34
Rate for Payer: United Healthcare Medicaid	$95.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$95.77

HC ALCOHOL AND/OR DRUG SVCS, GROUP

Facility

$159.00

Service Code	CPT H0005
Hospital Charge Code	900H000501
Hospital Revenue Code	900
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$127.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.89
Rate for Payer: Aetna Government	$16.89
Rate for Payer: Brighton Health Commercial	$119.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.12
Rate for Payer: EmblemHealth Commercial	$79.50
Rate for Payer: Group Health Inc Commercial	$79.50
Rate for Payer: Group Health Inc Medicare	$55.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.50
Rate for Payer: Hamaspik Choice Inc Medicare	$79.50
Rate for Payer: United Healthcare Commercial	$79.50

HC ALCOHOL AND/OR DRUG SVCS, GROUP

Facility

$159.00

Service Code	CPT H0005
Hospital Charge Code	900H000501
Hospital Revenue Code	900
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$79.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.50

HC ALCOHOL AND/OR OTHER DRUG TREATMENT PROGRAM, PER DIEM

Facility

$297.00

Service Code	CPT H2036
Hospital Charge Code	900H203601
Hospital Revenue Code	900
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$491.49
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	$430.90
Rate for Payer: Affinity Essential Plan 3&4	$430.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$191.51
Rate for Payer: Amida Care Medicaid	$191.51
Rate for Payer: Brighton Health Commercial	$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: EmblemHealth Commercial	$148.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$430.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$191.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$191.51
Rate for Payer: Fidelis Essential Plan Aliesa	$430.90
Rate for Payer: Fidelis Essential Plan QHP	$430.90
Rate for Payer: Fidelis Qualified Health Plan	$201.08
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	$191.51
Rate for Payer: Hamaspik Choice Inc Medicare	$191.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.51
Rate for Payer: Healthfirst Essential Plan	$430.90
Rate for Payer: Healthfirst QHP	$312.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.51
Rate for Payer: SOMOS Essential	$430.90
Rate for Payer: United Healthcare Commercial	$148.50
Rate for Payer: United Healthcare Essential Plan 1&2	$430.90
Rate for Payer: United Healthcare Essential Plan 3&4	$210.66
Rate for Payer: United Healthcare Medicaid	$191.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$191.51

HC ALCOHOL AND/OR OTHER DRUG TREATMENT PROGRAM, PER DIEM

Facility

$297.00

Service Code	CPT H2036
Hospital Charge Code	900H203601
Hospital Revenue Code	900
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$148.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$148.50

HC ALCOHOL/DRG METH ADMINISTRATION

Facility

$82.00

Service Code	CPT H0020
Hospital Charge Code	900H002001
Hospital Revenue Code	900
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$41.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.00

HC ALCOHOL/DRG METH ADMINISTRATION

Facility

$82.00

Service Code	CPT H0020
Hospital Charge Code	900H002001
Hospital Revenue Code	900
Min. Negotiated Rate	$24.64
Max. Negotiated Rate	$65.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.64
Rate for Payer: Aetna Government	$24.64
Rate for Payer: Brighton Health Commercial	$61.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.76
Rate for Payer: EmblemHealth Commercial	$41.00
Rate for Payer: Group Health Inc Commercial	$41.00
Rate for Payer: Group Health Inc Medicare	$28.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.00
Rate for Payer: Hamaspik Choice Inc Medicare	$41.00
Rate for Payer: United Healthcare Commercial	$41.00

HC ALCOHOL/DRG SERVICE, BRIEF INTERVENTION, PER 15 MIN

Facility

$142.00

Service Code	CPT H0050
Hospital Charge Code	900H005001
Hospital Revenue Code	900
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00

HC ALCOHOL/DRG SERVICE, BRIEF INTERVENTION, PER 15 MIN

Facility

$142.00

Service Code	CPT H0050
Hospital Charge Code	900H005001
Hospital Revenue Code	900
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$145.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$145.96
Rate for Payer: Affinity Essential Plan 3&4	$145.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$64.87
Rate for Payer: Amida Care Medicaid	$64.87
Rate for Payer: Brighton Health Commercial	$106.50
Rate for Payer: Carelon Behavioral Health HARP/QHP	$64.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.56
Rate for Payer: EmblemHealth Commercial	$71.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$145.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$64.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64.87
Rate for Payer: Fidelis Essential Plan Aliesa	$145.96
Rate for Payer: Fidelis Essential Plan QHP	$145.96
Rate for Payer: Fidelis Qualified Health Plan	$68.11
Rate for Payer: Group Health Inc Commercial	$71.00
Rate for Payer: Group Health Inc Medicare	$49.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.87
Rate for Payer: Hamaspik Choice Inc Medicare	$64.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64.87
Rate for Payer: Healthfirst Essential Plan	$145.96
Rate for Payer: Healthfirst QHP	$105.74
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$64.87
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$145.96
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$145.96
Rate for Payer: Optum Medicaid	$0.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.87
Rate for Payer: SOMOS Essential	$145.96
Rate for Payer: United Healthcare Commercial	$71.00
Rate for Payer: United Healthcare Essential Plan 1&2	$145.96
Rate for Payer: United Healthcare Essential Plan 3&4	$71.36
Rate for Payer: United Healthcare Medicaid	$64.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.87

HC ALCOHOL/DRUG ABUSE SVC, NOC

Facility

$20.00

Service Code	CPT H0047
Hospital Charge Code	900H004701
Hospital Revenue Code	900
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00

HC ALCOHOL/DRUG ABUSE SVC, NOC

Facility

$20.00

Service Code	CPT H0047
Hospital Charge Code	900H004701
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: EmblemHealth Commercial	$10.00
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

HC ALCOHOL/DRUG SCREENING

Facility

$57.00

Service Code	CPT H0049
Hospital Charge Code	900H004901
Hospital Revenue Code	900
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$45.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$42.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$45.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.76
Rate for Payer: EmblemHealth Commercial	$28.50
Rate for Payer: Group Health Inc Commercial	$28.50
Rate for Payer: Group Health Inc Medicare	$19.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50
Rate for Payer: Hamaspik Choice Inc Medicare	$28.50
Rate for Payer: United Healthcare Commercial	$28.50

HC ALCOHOL/DRUG SCREENING

Facility

$57.00

Service Code	CPT H0049
Hospital Charge Code	900H004901
Hospital Revenue Code	900
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50

HC ALCOHOL &/OR DRUG INTERVENTION - OP

Facility

$10.00

Service Code	CPT H0007
Hospital Charge Code	900H000701
Hospital Revenue Code	900
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC ALCOHOL &/OR DRUG INTERVENTION - OP

Facility

$10.00

Service Code	CPT H0007
Hospital Charge Code	900H000701
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: EmblemHealth Commercial	$5.00
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

HC ALCOHOL &/OR DRUG INTERVENTION-PLANNED

Facility

$10.00

Service Code	CPT H0022
Hospital Charge Code	900H002201
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: EmblemHealth Commercial	$5.00
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

Know your out-of-pocket cost for care.

All Charges