St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CARDIOPULMONARY EXERCISE TESTING - COMPLEX STRESS TEST, PULMONARY

Facility

$766.00

Service Code	CPT 94621
Hospital Charge Code	4609462101
Hospital Revenue Code	460
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC CARDIOVASCULAR TREADMILL STRESS TEST

Facility

$766.00

Service Code	CPT 93015
Hospital Charge Code	4829301501
Hospital Revenue Code	482
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC CARDIOVASCULAR TREADMILL STRESS TEST

Facility

$766.00

Service Code	CPT 93015
Hospital Charge Code	4829301501
Hospital Revenue Code	482
Min. Negotiated Rate	$66.61
Max. Negotiated Rate	$697.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.61
Rate for Payer: Aetna Government	$66.61
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: EmblemHealth Commercial	$383.00
Rate for Payer: Group Health Inc Commercial	$383.00
Rate for Payer: Group Health Inc Medicare	$268.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00
Rate for Payer: Hamaspik Choice Inc Medicare	$383.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$82.65
Rate for Payer: United Healthcare Commercial	$697.00

HC CARDIOVERSION, ELECTIVE;EXTERN

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4819296001
Hospital Revenue Code	481
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119.54
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC CARDIOVERSION, ELECTIVE;EXTERN

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4819296001
Hospital Revenue Code	481
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296001
Hospital Revenue Code	480
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296001
Hospital Revenue Code	480
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$1,299.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$1,218.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.32
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119.54
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296003
Hospital Revenue Code	480
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$1,299.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$1,218.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.32
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119.54
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296003
Hospital Revenue Code	480
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ COLOR AND CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296004
Hospital Revenue Code	480
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC CARDIOVERSION ELECTRIC EXT - TEE COMPLETE W/ COLOR AND CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296004
Hospital Revenue Code	480
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$1,299.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$1,218.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.32
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119.54
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC CARDIOVERSION ELECTRIC EXT - TEE W/ DOPPLER, COLOR AND CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296005
Hospital Revenue Code	480
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC CARDIOVERSION ELECTRIC EXT - TEE W/ DOPPLER, COLOR AND CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296005
Hospital Revenue Code	480
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$1,299.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$1,218.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.32
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119.54
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC CARDIOVERSION ELECTRIC EXT - TRANSESOPHAGEAL ECHO W/ CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296002
Hospital Revenue Code	480
Min. Negotiated Rate	$119.54
Max. Negotiated Rate	$1,299.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$1,218.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.32
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119.54
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC CARDIOVERSION ELECTRIC EXT - TRANSESOPHAGEAL ECHO W/ CARDIOVERSION

Facility

$1,624.00

Service Code	CPT 92960
Hospital Charge Code	4809296002
Hospital Revenue Code	480
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC CARDIOVERSION ELECTRIC INT - CARDIOVERSION INTERNAL

Facility

$1,624.00

Service Code	CPT 92961
Hospital Charge Code	4809296101
Hospital Revenue Code	480
Min. Negotiated Rate	$280.82
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$1,218.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.32
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$280.82
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC CARDIOVERSION ELECTRIC INT - CARDIOVERSION INTERNAL

Facility

$1,624.00

Service Code	CPT 92961
Hospital Charge Code	4809296101
Hospital Revenue Code	480
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM

Facility

$88.00

Service Code	CPT 96161
Hospital Charge Code	9189616101
Hospital Revenue Code	918
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$70.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.40
Rate for Payer: Aetna Government	$36.40
Rate for Payer: Affinity Essential Plan 1&2	$25.48
Rate for Payer: Affinity Essential Plan 3&4	$25.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$25.48
Rate for Payer: Brighton Health Commercial	$66.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$36.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.84
Rate for Payer: Elderplan Medicare Advantage	$36.40
Rate for Payer: EmblemHealth Commercial	$36.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32.76
Rate for Payer: Fidelis Essential Plan Aliesa	$30.94
Rate for Payer: Fidelis Essential Plan QHP	$32.40
Rate for Payer: Fidelis Medicare Advantage	$36.40
Rate for Payer: Fidelis Qualified Health Plan	$32.40
Rate for Payer: Group Health Inc Commercial	$36.40
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.40
Rate for Payer: Hamaspik Choice Inc Medicare	$36.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.49
Rate for Payer: Healthfirst Medicare Advantage	$30.94
Rate for Payer: Healthfirst QHP	$36.40
Rate for Payer: Humana Medicare	$37.13
Rate for Payer: Senior Whole Health Medicare Advantage	$36.40
Rate for Payer: United Healthcare Commercial	$44.00
Rate for Payer: United Healthcare Medicare Advantage	$36.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.58
Rate for Payer: Wellcare Medicare	$34.58

HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM

Facility

$88.00

Service Code	CPT 96161
Hospital Charge Code	9189616101
Hospital Revenue Code	918
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$44.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.00

HC CARE MGMT SVC BHVL HLTH COND

Facility

$54.00

Service Code	CPT 99484
Hospital Charge Code	9009948401
Hospital Revenue Code	900
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.00

HC CARE MGMT SVC BHVL HLTH COND

Facility

$54.00

Service Code	CPT 99484
Hospital Charge Code	9009948401
Hospital Revenue Code	900
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$46.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.40
Rate for Payer: Aetna Government	$36.40
Rate for Payer: Affinity Essential Plan 1&2	$25.48
Rate for Payer: Affinity Essential Plan 3&4	$25.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$25.48
Rate for Payer: Brighton Health Commercial	$40.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$36.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.72
Rate for Payer: Elderplan Medicare Advantage	$36.40
Rate for Payer: EmblemHealth Commercial	$36.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32.76
Rate for Payer: Fidelis Essential Plan Aliesa	$30.94
Rate for Payer: Fidelis Essential Plan QHP	$32.40
Rate for Payer: Fidelis Medicare Advantage	$36.40
Rate for Payer: Fidelis Qualified Health Plan	$32.40
Rate for Payer: Group Health Inc Commercial	$36.40
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.40
Rate for Payer: Hamaspik Choice Inc Medicare	$36.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46.77
Rate for Payer: Healthfirst Medicare Advantage	$30.94
Rate for Payer: Healthfirst QHP	$36.40
Rate for Payer: Humana Medicare	$37.13
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$38.22
Rate for Payer: Senior Whole Health Medicare Advantage	$36.40
Rate for Payer: United Healthcare Commercial	$27.00
Rate for Payer: United Healthcare Medicare Advantage	$36.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$36.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.58
Rate for Payer: Wellcare Medicare	$34.58

HC CASE MANAGEMENT, PER MONTH

Facility

$112.00

Service Code	CPT T2022
Hospital Charge Code	969T202201
Hospital Revenue Code	969
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00

HC CASE MANAGEMENT, PER MONTH

Facility

$112.00

Service Code	CPT T2022
Hospital Charge Code	969T202201
Hospital Revenue Code	969
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$180.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.00
Rate for Payer: Aetna Government	$180.00
Rate for Payer: Brighton Health Commercial	$84.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.16
Rate for Payer: EmblemHealth Commercial	$56.00
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00

HC CASIRIVIMAB INFUSION ADMINISTRATION

Facility

$1,357.00

Service Code	CPT M0243
Hospital Charge Code	260M024302
Hospital Revenue Code	260
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$1,085.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$746.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$1,017.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,085.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$922.76
Rate for Payer: EmblemHealth Commercial	$678.50
Rate for Payer: Group Health Inc Commercial	$678.50
Rate for Payer: Group Health Inc Medicare	$474.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$678.50
Rate for Payer: Hamaspik Choice Inc Medicare	$678.50
Rate for Payer: United Healthcare Commercial	$76.00

HC CASIRIVIMAB INFUSION ADMINISTRATION

Facility

$1,357.00

Service Code	CPT M0243
Hospital Charge Code	260M024302
Hospital Revenue Code	260
Min. Negotiated Rate	$678.50
Max. Negotiated Rate	$678.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$678.50

Know your out-of-pocket cost for care.

All Charges