St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC EEG PHYS/QHP EA INCR W/O VID

Facility

$1,470.00

Service Code	CPT 95719
Hospital Charge Code	7409571901
Hospital Revenue Code	740
Min. Negotiated Rate	$139.38
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$139.38
Rate for Payer: Aetna Government	$139.38
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: EmblemHealth Commercial	$735.00
Rate for Payer: Group Health Inc Commercial	$735.00
Rate for Payer: Group Health Inc Medicare	$514.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00
Rate for Payer: Hamaspik Choice Inc Medicare	$735.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$176.79
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG PHYS/QHP EA INCR W/O VID

Facility

$1,470.00

Service Code	CPT 95719
Hospital Charge Code	7409571901
Hospital Revenue Code	740
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC EEG,W/AWAKE & ASLEEP RECORD

Facility

$766.00

Service Code	CPT 95819 TC
Hospital Charge Code	7409581901
Hospital Revenue Code	740
Min. Negotiated Rate	$268.10
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$320.70
Rate for Payer: Aetna Government	$320.70
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	$461.89
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG,W/AWAKE & ASLEEP RECORD

Facility

$766.00

Service Code	CPT 95819 TC
Hospital Charge Code	7409581901
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG,W/AWAKE & DROWSY RECORD - EEG AWAKE OR DROWSY PORTABLE

Facility

$766.00

Service Code	CPT 95816 TC
Hospital Charge Code	7409581601
Hospital Revenue Code	740
Min. Negotiated Rate	$268.10
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$273.82
Rate for Payer: Aetna Government	$273.82
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	$387.53
Rate for Payer: United Healthcare Commercial	$822.00

HC EEG,W/AWAKE & DROWSY RECORD - EEG AWAKE OR DROWSY PORTABLE

Facility

$766.00

Service Code	CPT 95816 TC
Hospital Charge Code	7409581601
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG W/O VID 12-26 HR INTERMIT MON

Facility

$1,470.00

Service Code	CPT 95709
Hospital Charge Code	7409570901
Hospital Revenue Code	740
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC EEG W/O VID 12-26 HR INTERMIT MON

Facility

$1,470.00

Service Code	CPT 95709
Hospital Charge Code	7409570901
Hospital Revenue Code	740
Min. Negotiated Rate	$453.81
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$648.30
Rate for Payer: Aetna Government	$648.30
Rate for Payer: Affinity Essential Plan 1&2	$453.81
Rate for Payer: Affinity Essential Plan 3&4	$453.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$453.81
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$648.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: Elderplan Medicare Advantage	$648.30
Rate for Payer: EmblemHealth Commercial	$648.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$583.47
Rate for Payer: Fidelis Essential Plan Aliesa	$551.05
Rate for Payer: Fidelis Essential Plan QHP	$576.99
Rate for Payer: Fidelis Medicare Advantage	$648.30
Rate for Payer: Fidelis Qualified Health Plan	$576.99
Rate for Payer: Group Health Inc Commercial	$648.30
Rate for Payer: Group Health Inc Medicare	$648.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.30
Rate for Payer: Hamaspik Choice Inc Medicare	$648.30
Rate for Payer: Healthfirst Medicare Advantage	$551.05
Rate for Payer: Healthfirst QHP	$648.30
Rate for Payer: Humana Medicare	$661.27
Rate for Payer: Senior Whole Health Medicare Advantage	$648.30
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$648.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$615.88
Rate for Payer: Wellcare Medicare	$615.88

HC EEG W/O VID 12-26HR UNMONITORED

Facility

$1,470.00

Service Code	CPT 95708
Hospital Charge Code	7409570801
Hospital Revenue Code	740
Min. Negotiated Rate	$453.81
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$648.30
Rate for Payer: Aetna Government	$648.30
Rate for Payer: Affinity Essential Plan 1&2	$453.81
Rate for Payer: Affinity Essential Plan 3&4	$453.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$453.81
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$648.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: Elderplan Medicare Advantage	$648.30
Rate for Payer: EmblemHealth Commercial	$648.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$583.47
Rate for Payer: Fidelis Essential Plan Aliesa	$551.05
Rate for Payer: Fidelis Essential Plan QHP	$576.99
Rate for Payer: Fidelis Medicare Advantage	$648.30
Rate for Payer: Fidelis Qualified Health Plan	$576.99
Rate for Payer: Group Health Inc Commercial	$648.30
Rate for Payer: Group Health Inc Medicare	$648.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.30
Rate for Payer: Hamaspik Choice Inc Medicare	$648.30
Rate for Payer: Healthfirst Medicare Advantage	$551.05
Rate for Payer: Healthfirst QHP	$648.30
Rate for Payer: Humana Medicare	$661.27
Rate for Payer: Senior Whole Health Medicare Advantage	$648.30
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$648.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$615.88
Rate for Payer: Wellcare Medicare	$615.88

HC EEG W/O VID 12-26HR UNMONITORED

Facility

$1,470.00

Service Code	CPT 95708
Hospital Charge Code	7409570801
Hospital Revenue Code	740
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC EEG W/O VID 2-12 HR CONT MONITOR

Facility

$766.00

Service Code	CPT 95707
Hospital Charge Code	7409570701
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG W/O VID 2-12 HR CONT MONITOR

Facility

$766.00

Service Code	CPT 95707
Hospital Charge Code	7409570701
Hospital Revenue Code	740
Min. Negotiated Rate	$266.33
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: Elderplan Medicare Advantage	$380.47
Rate for Payer: EmblemHealth Commercial	$380.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
Rate for Payer: Group Health Inc Commercial	$380.47
Rate for Payer: Group Health Inc Medicare	$380.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

HC EEG W/O VID 2-12 HR INTERMIT MON

Facility

$766.00

Service Code	CPT 95706
Hospital Charge Code	7409570601
Hospital Revenue Code	740
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EEG W/O VID 2-12 HR INTERMIT MON

Facility

$766.00

Service Code	CPT 95706
Hospital Charge Code	7409570601
Hospital Revenue Code	740
Min. Negotiated Rate	$266.33
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: Elderplan Medicare Advantage	$380.47
Rate for Payer: EmblemHealth Commercial	$380.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
Rate for Payer: Group Health Inc Commercial	$380.47
Rate for Payer: Group Health Inc Medicare	$380.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

HC EEG W/O VID 2-12 HR UNATTENDED

Facility

$1,470.00

Service Code	CPT 95714
Hospital Charge Code	7409571401
Hospital Revenue Code	740
Min. Negotiated Rate	$453.81
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$648.30
Rate for Payer: Aetna Government	$648.30
Rate for Payer: Affinity Essential Plan 1&2	$453.81
Rate for Payer: Affinity Essential Plan 3&4	$453.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$453.81
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$648.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: Elderplan Medicare Advantage	$648.30
Rate for Payer: EmblemHealth Commercial	$648.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$583.47
Rate for Payer: Fidelis Essential Plan Aliesa	$551.05
Rate for Payer: Fidelis Essential Plan QHP	$576.99
Rate for Payer: Fidelis Medicare Advantage	$648.30
Rate for Payer: Fidelis Qualified Health Plan	$576.99
Rate for Payer: Group Health Inc Commercial	$648.30
Rate for Payer: Group Health Inc Medicare	$648.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.30
Rate for Payer: Hamaspik Choice Inc Medicare	$648.30
Rate for Payer: Healthfirst Medicare Advantage	$551.05
Rate for Payer: Healthfirst QHP	$648.30
Rate for Payer: Humana Medicare	$661.27
Rate for Payer: Senior Whole Health Medicare Advantage	$648.30
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$648.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$615.88
Rate for Payer: Wellcare Medicare	$615.88

HC EEG W/O VID 2-12 HR UNATTENDED

Facility

$1,470.00

Service Code	CPT 95714
Hospital Charge Code	7409571401
Hospital Revenue Code	740
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC EEG W/O VID 2-12 HR UNMNTR

Facility

$814.00

Service Code	CPT 95705
Hospital Charge Code	7409570501
Hospital Revenue Code	740
Min. Negotiated Rate	$266.33
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$447.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$610.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$651.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$553.52
Rate for Payer: Elderplan Medicare Advantage	$380.47
Rate for Payer: EmblemHealth Commercial	$380.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
Rate for Payer: Group Health Inc Commercial	$380.47
Rate for Payer: Group Health Inc Medicare	$380.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

HC EEG W/O VID 2-12 HR UNMNTR

Facility

$814.00

Service Code	CPT 95705
Hospital Charge Code	7409570501
Hospital Revenue Code	740
Min. Negotiated Rate	$407.00
Max. Negotiated Rate	$407.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$407.00

HC EEG WO VID EA 12-26HR UNMNTR

Facility

$1,502.00

Service Code	CPT 95710
Hospital Charge Code	7409571001
Hospital Revenue Code	740
Min. Negotiated Rate	$453.81
Max. Negotiated Rate	$1,201.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$826.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$648.30
Rate for Payer: Aetna Government	$648.30
Rate for Payer: Affinity Essential Plan 1&2	$453.81
Rate for Payer: Affinity Essential Plan 3&4	$453.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$453.81
Rate for Payer: Brighton Health Commercial	$1,126.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$648.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,201.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,021.36
Rate for Payer: Elderplan Medicare Advantage	$648.30
Rate for Payer: EmblemHealth Commercial	$648.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$583.47
Rate for Payer: Fidelis Essential Plan Aliesa	$551.05
Rate for Payer: Fidelis Essential Plan QHP	$576.99
Rate for Payer: Fidelis Medicare Advantage	$648.30
Rate for Payer: Fidelis Qualified Health Plan	$576.99
Rate for Payer: Group Health Inc Commercial	$648.30
Rate for Payer: Group Health Inc Medicare	$648.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.30
Rate for Payer: Hamaspik Choice Inc Medicare	$648.30
Rate for Payer: Healthfirst Medicare Advantage	$551.05
Rate for Payer: Healthfirst QHP	$648.30
Rate for Payer: Humana Medicare	$661.27
Rate for Payer: Senior Whole Health Medicare Advantage	$648.30
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$648.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$615.88
Rate for Payer: Wellcare Medicare	$615.88

HC EEG WO VID EA 12-26HR UNMNTR

Facility

$1,502.00

Service Code	CPT 95710
Hospital Charge Code	7409571001
Hospital Revenue Code	740
Min. Negotiated Rate	$751.00
Max. Negotiated Rate	$751.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$751.00

HC EGD FLEXIBLE FOREIGN BODY REMOVAL

Facility

$2,159.00

Service Code	CPT 43247
Hospital Charge Code	7504324701
Hospital Revenue Code	750
Min. Negotiated Rate	$198.63
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,145.53
Rate for Payer: Aetna Government	$1,145.53
Rate for Payer: Affinity Essential Plan 1&2	$801.87
Rate for Payer: Affinity Essential Plan 3&4	$801.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$801.87
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,145.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$1,145.53
Rate for Payer: EmblemHealth Commercial	$1,145.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,030.98
Rate for Payer: Fidelis Essential Plan Aliesa	$973.70
Rate for Payer: Fidelis Essential Plan QHP	$1,019.52
Rate for Payer: Fidelis Medicare Advantage	$1,145.53
Rate for Payer: Fidelis Qualified Health Plan	$1,019.52
Rate for Payer: Group Health Inc Commercial	$1,145.53
Rate for Payer: Group Health Inc Medicare	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicare	$503.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$198.63
Rate for Payer: Healthfirst Medicare Advantage	$973.70
Rate for Payer: Healthfirst QHP	$1,145.53
Rate for Payer: Humana Medicare	$1,168.44
Rate for Payer: Senior Whole Health Medicare Advantage	$1,145.53
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,145.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,145.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,088.25
Rate for Payer: Wellcare Medicare	$1,088.25

HC EGD FLEXIBLE FOREIGN BODY REMOVAL

Facility

$2,159.00

Service Code	CPT 43247
Hospital Charge Code	7504324701
Hospital Revenue Code	750
Min. Negotiated Rate	$1,079.50
Max. Negotiated Rate	$1,079.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.50

HC EGD FLEXIBLE FOREIGN BODY REMOVAL - EGD

Facility

$2,159.00

Service Code	CPT 43247
Hospital Charge Code	7504324702
Hospital Revenue Code	750
Min. Negotiated Rate	$198.63
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,145.53
Rate for Payer: Aetna Government	$1,145.53
Rate for Payer: Affinity Essential Plan 1&2	$801.87
Rate for Payer: Affinity Essential Plan 3&4	$801.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$801.87
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,145.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$1,145.53
Rate for Payer: EmblemHealth Commercial	$1,145.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,030.98
Rate for Payer: Fidelis Essential Plan Aliesa	$973.70
Rate for Payer: Fidelis Essential Plan QHP	$1,019.52
Rate for Payer: Fidelis Medicare Advantage	$1,145.53
Rate for Payer: Fidelis Qualified Health Plan	$1,019.52
Rate for Payer: Group Health Inc Commercial	$1,145.53
Rate for Payer: Group Health Inc Medicare	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicare	$503.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$198.63
Rate for Payer: Healthfirst Medicare Advantage	$973.70
Rate for Payer: Healthfirst QHP	$1,145.53
Rate for Payer: Humana Medicare	$1,168.44
Rate for Payer: Senior Whole Health Medicare Advantage	$1,145.53
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,145.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,145.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,088.25
Rate for Payer: Wellcare Medicare	$1,088.25

HC EGD FLEXIBLE FOREIGN BODY REMOVAL - EGD

Facility

$2,159.00

Service Code	CPT 43247
Hospital Charge Code	7504324702
Hospital Revenue Code	750
Min. Negotiated Rate	$1,079.50
Max. Negotiated Rate	$1,079.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,079.50

HC EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY - EGD

Facility

$4,716.00

Service Code	CPT 43242
Hospital Charge Code	7504324201
Hospital Revenue Code	750
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$2,358.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.00

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