St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC INFLUENZA VIRUS - INFLUENZA TYPE A&B ANTIBODIES

Facility

$42.00

Service Code	CPT 86710
Hospital Charge Code	3028671003
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00

HC INFLUENZA VIRUS - INFLUENZA TYPE B ANTIBODY

Facility

$42.00

Service Code	CPT 86710
Hospital Charge Code	3028671002
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00

HC INFLUENZA VIRUS - INFLUENZA TYPE B ANTIBODY

Facility

$42.00

Service Code	CPT 86710
Hospital Charge Code	3028671002
Hospital Revenue Code	302
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.55
Rate for Payer: Aetna Government	$13.55
Rate for Payer: Affinity Essential Plan 1&2	$9.48
Rate for Payer: Affinity Essential Plan 3&4	$9.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.48
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.40
Rate for Payer: Elderplan Medicare Advantage	$13.55
Rate for Payer: EmblemHealth Commercial	$13.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.20
Rate for Payer: Fidelis Essential Plan Aliesa	$11.52
Rate for Payer: Fidelis Essential Plan QHP	$12.06
Rate for Payer: Fidelis Medicare Advantage	$13.55
Rate for Payer: Fidelis Qualified Health Plan	$12.06
Rate for Payer: Group Health Inc Commercial	$13.55
Rate for Payer: Group Health Inc Medicare	$13.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.55
Rate for Payer: Hamaspik Choice Inc Medicare	$13.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$13.55
Rate for Payer: Healthfirst Essential Plan	$30.49
Rate for Payer: Healthfirst Medicare Advantage	$13.55
Rate for Payer: Healthfirst QHP	$13.55
Rate for Payer: Humana Medicare	$13.82
Rate for Payer: Senior Whole Health Medicare Advantage	$13.55
Rate for Payer: United Healthcare Commercial	$17.17
Rate for Payer: United Healthcare Medicare Advantage	$13.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.55
Rate for Payer: Wellcare Medicare	$12.20

HC INFLUENZA VIRUS VACCINE

Facility

$38.00

Service Code	CPT 90668
Hospital Charge Code	6369066801
Hospital Revenue Code	636
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$24.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.00
Rate for Payer: Aetna Government	$19.00
Rate for Payer: Brighton Health Commercial	$22.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.85
Rate for Payer: EmblemHealth Commercial	$19.00
Rate for Payer: Group Health Inc Commercial	$19.00
Rate for Payer: Group Health Inc Medicare	$13.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.70

HC INFLUENZA VIRUS VACCINE

Facility

$38.00

Service Code	CPT 90668
Hospital Charge Code	6369066801
Hospital Revenue Code	636
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00
Rate for Payer: Hamaspik Choice Inc Medicare	$19.00

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (AIIV4), INACTIVATED, ADJUVANTED 0.5 ML DOSAGE

Facility

$536.00

Service Code	CPT 90694
Hospital Charge Code	6369069401
Hospital Revenue Code	636
Min. Negotiated Rate	$268.00
Max. Negotiated Rate	$268.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$268.00
Rate for Payer: Hamaspik Choice Inc Medicare	$268.00

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (AIIV4), INACTIVATED, ADJUVANTED 0.5 ML DOSAGE

Facility

$536.00

Service Code	CPT 90694
Hospital Charge Code	6369069401
Hospital Revenue Code	636
Min. Negotiated Rate	$66.43
Max. Negotiated Rate	$348.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.43
Rate for Payer: Aetna Government	$66.43
Rate for Payer: Brighton Health Commercial	$321.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.20
Rate for Payer: EmblemHealth Commercial	$268.00
Rate for Payer: Group Health Inc Commercial	$268.00
Rate for Payer: Group Health Inc Medicare	$187.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$268.00
Rate for Payer: Hamaspik Choice Inc Medicare	$268.00
Rate for Payer: United Healthcare Commercial	$71.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$348.40

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (CCIIV4), DERIVED FROM CELL CULTURES 0.5 ML DOSAGE

Facility

$279.00

Service Code	CPT 90674
Hospital Charge Code	6369067401
Hospital Revenue Code	636
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$181.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$153.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.94
Rate for Payer: Aetna Government	$29.94
Rate for Payer: Brighton Health Commercial	$167.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$160.43
Rate for Payer: EmblemHealth Commercial	$139.50
Rate for Payer: Group Health Inc Commercial	$139.50
Rate for Payer: Group Health Inc Medicare	$97.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.50
Rate for Payer: Hamaspik Choice Inc Medicare	$139.50
Rate for Payer: United Healthcare Commercial	$32.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$181.35

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (CCIIV4), DERIVED FROM CELL CULTURES 0.5 ML DOSAGE

Facility

$279.00

Service Code	CPT 90674
Hospital Charge Code	6369067401
Hospital Revenue Code	636
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.50
Rate for Payer: Hamaspik Choice Inc Medicare	$139.50

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (CCIIV4), DERIVED FROM CELL CULTURES 0.5ML DOSAGE

Facility

$94.00

Service Code	CPT 90756
Hospital Charge Code	6369075601
Hospital Revenue Code	636
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$47.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (CCIIV4), DERIVED FROM CELL CULTURES 0.5ML DOSAGE

Facility

$94.00

Service Code	CPT 90756
Hospital Charge Code	6369075601
Hospital Revenue Code	636
Min. Negotiated Rate	$28.37
Max. Negotiated Rate	$61.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.37
Rate for Payer: Aetna Government	$28.37
Rate for Payer: Brighton Health Commercial	$56.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.05
Rate for Payer: EmblemHealth Commercial	$47.00
Rate for Payer: Group Health Inc Commercial	$47.00
Rate for Payer: Group Health Inc Medicare	$32.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00
Rate for Payer: United Healthcare Commercial	$30.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.10

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (RIV4), DERIVED FROM RECOMBINANT DNA, HEMAGGLUTININ (HA) PROTEIN ONLY

Facility

$796.00

Service Code	CPT 90682
Hospital Charge Code	6369068201
Hospital Revenue Code	636
Min. Negotiated Rate	$398.00
Max. Negotiated Rate	$398.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.00
Rate for Payer: Hamaspik Choice Inc Medicare	$398.00

HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (RIV4), DERIVED FROM RECOMBINANT DNA, HEMAGGLUTININ (HA) PROTEIN ONLY

Facility

$796.00

Service Code	CPT 90682
Hospital Charge Code	6369068201
Hospital Revenue Code	636
Min. Negotiated Rate	$65.26
Max. Negotiated Rate	$517.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$437.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.26
Rate for Payer: Aetna Government	$65.26
Rate for Payer: Brighton Health Commercial	$477.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$398.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$457.70
Rate for Payer: EmblemHealth Commercial	$398.00
Rate for Payer: Group Health Inc Commercial	$398.00
Rate for Payer: Group Health Inc Medicare	$278.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$398.00
Rate for Payer: Hamaspik Choice Inc Medicare	$398.00
Rate for Payer: United Healthcare Commercial	$69.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$517.40

HC INFLUENZA VIRUS VACCINE, SPLIT VIRUS 3 YRS AND OLDER

Facility

$24.00

Service Code	CPT Q2038
Hospital Charge Code	636Q203801
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12.00

HC INFLUENZA VIRUS VACCINE, SPLIT VIRUS 3 YRS AND OLDER

Facility

$24.00

Service Code	CPT Q2038
Hospital Charge Code	636Q203801
Hospital Revenue Code	636
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$73.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.68
Rate for Payer: Aetna Government	$12.68
Rate for Payer: Brighton Health Commercial	$14.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.80
Rate for Payer: EmblemHealth Commercial	$12.00
Rate for Payer: Group Health Inc Commercial	$12.00
Rate for Payer: Group Health Inc Medicare	$8.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.00
Rate for Payer: Hamaspik Choice Inc Medicare	$12.00
Rate for Payer: United Healthcare Commercial	$73.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.60

HC INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES

Facility

$343.00

Service Code	CPT 95079
Hospital Charge Code	9249507901
Hospital Revenue Code	924
Min. Negotiated Rate	$171.50
Max. Negotiated Rate	$171.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.50

HC INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES

Facility

$343.00

Service Code	CPT 95079
Hospital Charge Code	9249507901
Hospital Revenue Code	924
Min. Negotiated Rate	$56.84
Max. Negotiated Rate	$274.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.84
Rate for Payer: Aetna Government	$56.84
Rate for Payer: Brighton Health Commercial	$257.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$274.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.24
Rate for Payer: EmblemHealth Commercial	$171.50
Rate for Payer: Group Health Inc Commercial	$171.50
Rate for Payer: Group Health Inc Medicare	$120.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.50
Rate for Payer: Hamaspik Choice Inc Medicare	$171.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.53
Rate for Payer: United Healthcare Commercial	$171.50

HC INGESTION CHALLENGE TEST INITIAL 120 MINUTES

Facility

$1,470.00

Service Code	CPT 95076
Hospital Charge Code	9249507601
Hospital Revenue Code	924
Min. Negotiated Rate	$79.61
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 CHP/FHP/Medicaid	$79.61
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	$735.00
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 INGESTION CHALLENGE TEST INITIAL 120 MINUTES

Facility

$1,470.00

Service Code	CPT 95076
Hospital Charge Code	9249507601
Hospital Revenue Code	924
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC INHIBIN A

Facility

$38.00

Service Code	CPT 86336
Hospital Charge Code	3028633601
Hospital Revenue Code	302
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$28.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.59
Rate for Payer: Aetna Government	$15.59
Rate for Payer: Affinity Essential Plan 1&2	$10.91
Rate for Payer: Affinity Essential Plan 3&4	$10.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.91
Rate for Payer: Brighton Health Commercial	$28.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.29
Rate for Payer: Elderplan Medicare Advantage	$15.59
Rate for Payer: EmblemHealth Commercial	$15.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.03
Rate for Payer: Fidelis Essential Plan Aliesa	$13.25
Rate for Payer: Fidelis Essential Plan QHP	$13.88
Rate for Payer: Fidelis Medicare Advantage	$15.59
Rate for Payer: Fidelis Qualified Health Plan	$13.88
Rate for Payer: Group Health Inc Commercial	$15.59
Rate for Payer: Group Health Inc Medicare	$15.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.59
Rate for Payer: Hamaspik Choice Inc Medicare	$15.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.57
Rate for Payer: Healthfirst Essential Plan	$14.78
Rate for Payer: Healthfirst Medicare Advantage	$15.59
Rate for Payer: Healthfirst QHP	$15.59
Rate for Payer: Humana Medicare	$15.90
Rate for Payer: Senior Whole Health Medicare Advantage	$15.59
Rate for Payer: United Healthcare Commercial	$19.74
Rate for Payer: United Healthcare Medicare Advantage	$15.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.57
Rate for Payer: Wellcare Medicare	$14.03

HC INHIBIN A

Facility

$38.00

Service Code	CPT 86336
Hospital Charge Code	3028633601
Hospital Revenue Code	302
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00

HC INHIBIN A - ULTRASENSITIVE

Facility

$38.00

Service Code	CPT 86336
Hospital Charge Code	3028633602
Hospital Revenue Code	302
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$28.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.59
Rate for Payer: Aetna Government	$15.59
Rate for Payer: Affinity Essential Plan 1&2	$10.91
Rate for Payer: Affinity Essential Plan 3&4	$10.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.91
Rate for Payer: Brighton Health Commercial	$28.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.29
Rate for Payer: Elderplan Medicare Advantage	$15.59
Rate for Payer: EmblemHealth Commercial	$15.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.03
Rate for Payer: Fidelis Essential Plan Aliesa	$13.25
Rate for Payer: Fidelis Essential Plan QHP	$13.88
Rate for Payer: Fidelis Medicare Advantage	$15.59
Rate for Payer: Fidelis Qualified Health Plan	$13.88
Rate for Payer: Group Health Inc Commercial	$15.59
Rate for Payer: Group Health Inc Medicare	$15.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.59
Rate for Payer: Hamaspik Choice Inc Medicare	$15.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.57
Rate for Payer: Healthfirst Essential Plan	$14.78
Rate for Payer: Healthfirst Medicare Advantage	$15.59
Rate for Payer: Healthfirst QHP	$15.59
Rate for Payer: Humana Medicare	$15.90
Rate for Payer: Senior Whole Health Medicare Advantage	$15.59
Rate for Payer: United Healthcare Commercial	$19.74
Rate for Payer: United Healthcare Medicare Advantage	$15.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.57
Rate for Payer: Wellcare Medicare	$14.03

HC INHIBIN A - ULTRASENSITIVE

Facility

$38.00

Service Code	CPT 86336
Hospital Charge Code	3028633602
Hospital Revenue Code	302
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00

HC INITIAL CARE, PER DAY, FOR E/M OF NEWBORN AT OTHER THAN HOSPITAL/BIRTHING CENTER

Facility

$132.00

Service Code	CPT 99461
Hospital Charge Code	9879946101
Hospital Revenue Code	987
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$66.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.00

HC INITIAL CARE, PER DAY, FOR E/M OF NEWBORN AT OTHER THAN HOSPITAL/BIRTHING CENTER

Facility

$132.00

Service Code	CPT 99461
Hospital Charge Code	9879946101
Hospital Revenue Code	987
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$105.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.87
Rate for Payer: Aetna Government	$46.87
Rate for Payer: Brighton Health Commercial	$99.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$89.76
Rate for Payer: EmblemHealth Commercial	$66.00
Rate for Payer: Group Health Inc Commercial	$66.00
Rate for Payer: Group Health Inc Medicare	$46.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.00
Rate for Payer: Hamaspik Choice Inc Medicare	$66.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$66.21

Know your out-of-pocket cost for care.

All Charges