St. Barnabas Hospital

All Charges

Charge

Type

Price

ALBUMIN HUMAN 5%, (25GM/500 ML)

Facility OP

$27.93

Service Code	HCPCS P9041
Hospital Charge Code	41650394
Hospital Revenue Code	636
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$18.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.62
Rate for Payer: Aetna Government	$10.62
Rate for Payer: Cash Price	$10.62
Rate for Payer: Cash Price	$10.62
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.06
Rate for Payer: Elderplan Medicare Advantage	$10.62
Rate for Payer: EmblemHealth Commercial	$10.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.62
Rate for Payer: Fidelis Essential Plan Aliesa	$10.62
Rate for Payer: Fidelis Essential Plan QHP	$11.15
Rate for Payer: Fidelis Medicare Advantage	$10.62
Rate for Payer: Fidelis Qualified Health Plan	$11.15
Rate for Payer: Group Health Inc Commercial	$10.62
Rate for Payer: Group Health Inc Medicare	$10.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.96
Rate for Payer: Hamaspik Choice Inc Medicare	$13.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.62
Rate for Payer: Healthfirst Medicare Advantage	$9.02
Rate for Payer: Healthfirst QHP	$10.62
Rate for Payer: Senior Whole Health Medicare Advantage	$10.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.25
Rate for Payer: SOMOS Essential	$11.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.49
Rate for Payer: Wellcare Medicare	$10.08

ALBUMIN HUMAN 5%, (25GM/500 ML)

Facility OP

$27.93

Service Code	HCPCS P9041
Hospital Charge Code	41640394
Hospital Revenue Code	636
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$18.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.62
Rate for Payer: Aetna Government	$10.62
Rate for Payer: Cash Price	$10.62
Rate for Payer: Cash Price	$10.62
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.06
Rate for Payer: Elderplan Medicare Advantage	$10.62
Rate for Payer: EmblemHealth Commercial	$10.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.62
Rate for Payer: Fidelis Essential Plan Aliesa	$10.62
Rate for Payer: Fidelis Essential Plan QHP	$11.15
Rate for Payer: Fidelis Medicare Advantage	$10.62
Rate for Payer: Fidelis Qualified Health Plan	$11.15
Rate for Payer: Group Health Inc Commercial	$10.62
Rate for Payer: Group Health Inc Medicare	$10.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.96
Rate for Payer: Hamaspik Choice Inc Medicare	$13.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.62
Rate for Payer: Healthfirst Medicare Advantage	$9.02
Rate for Payer: Healthfirst QHP	$10.62
Rate for Payer: Senior Whole Health Medicare Advantage	$10.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11.25
Rate for Payer: SOMOS Essential	$11.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.49
Rate for Payer: Wellcare Medicare	$10.08

ALBUMIN HUMAN 5%, (25GM/500 ML)

Facility IP

$27.93

Service Code	HCPCS P9041
Hospital Charge Code	41650394
Hospital Revenue Code	636
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$13.96
Rate for Payer: Cash Price	$10.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.96
Rate for Payer: Hamaspik Choice Inc Medicare	$13.96

ALBUTEROL 0.1 MG/ML NEB SOLN NEONATE

Facility IP

$3.00

Service Code	HCPCS J7609
Hospital Charge Code	41653291
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

ALBUTEROL 0.1 MG/ML NEB SOLN NEONATE

Facility OP

$3.00

Service Code	HCPCS J7609
Hospital Charge Code	41653291
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ALBUTEROL 0.1 MG/ML NEB SOLN NEONATE

Facility OP

$3.00

Hospital Charge Code	41643291
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

ALBUTEROL 0.4 MG/ML SYRUP

Facility OP

$1.00

Hospital Charge Code	41644332
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ALBUTEROL 0.4 MG/ML SYRUP

Facility OP

$1.00

Hospital Charge Code	41654332
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ALBUTEROL 2.5 MG/3 ML NEB SOLN

Facility OP

$0.11

Service Code	HCPCS J7613
Hospital Charge Code	41643717
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.03
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.04
Rate for Payer: SOMOS Essential	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ALBUTEROL 2.5 MG/3 ML NEB SOLN

Facility IP

$0.11

Service Code	HCPCS J7613
Hospital Charge Code	41643717
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06

ALBUTEROL 2.5 MG/3 ML NEB SOLN

Facility OP

$0.11

Service Code	HCPCS J7613
Hospital Charge Code	41653717
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.03
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.04
Rate for Payer: SOMOS Essential	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

ALBUTEROL 2.5 MG/3 ML NEB SOLN

Facility IP

$0.11

Service Code	HCPCS J7613
Hospital Charge Code	41653717
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06

ALBUTEROL 2 MG TAB

Facility OP

$1.00

Hospital Charge Code	41651008
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ALBUTEROL 2 MG TAB

Facility OP

$1.00

Hospital Charge Code	41641008
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

ALBUTEROL 90 MCG/INH INHALER

Facility OP

$3.68

Hospital Charge Code	41655014
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$2.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.84
Rate for Payer: Aetna Government	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.50
Rate for Payer: Group Health Inc Commercial	$1.84
Rate for Payer: Group Health Inc Medicare	$1.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.39

ALBUTEROL 90 MCG/INH INHALER

Facility OP

$3.68

Hospital Charge Code	41645014
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$2.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.84
Rate for Payer: Aetna Government	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.50
Rate for Payer: Group Health Inc Commercial	$1.84
Rate for Payer: Group Health Inc Medicare	$1.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.39

ALBUTEROL HFA (FOR PYXIS OVERRIDE

Facility OP

$0.01

Hospital Charge Code	41648432
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ALBUTEROL HFA (FOR PYXIS OVERRIDE

Facility OP

$0.01

Hospital Charge Code	41658432
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

ALBUTEROL/IPRATROPIUM 2.5-0.5MG

Facility IP

$0.42

Service Code	HCPCS J7620
Hospital Charge Code	41647777
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21

ALBUTEROL/IPRATROPIUM 2.5-0.5MG

Facility OP

$0.42

Service Code	HCPCS J7620
Hospital Charge Code	41657777
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.12
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.21
Rate for Payer: SOMOS Essential	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

ALBUTEROL/IPRATROPIUM 2.5-0.5MG

Facility IP

$0.42

Service Code	HCPCS J7620
Hospital Charge Code	41657777
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21

ALBUTEROL/IPRATROPIUM 2.5-0.5MG

Facility OP

$0.42

Service Code	HCPCS J7620
Hospital Charge Code	41647777
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.12
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.21
Rate for Payer: SOMOS Essential	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

ALBUTEROL NEB SOL 5MG/ML 2ML -1MG

Facility OP

$0.03

Hospital Charge Code	41658035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ALBUTEROL NEB SOL 5MG/ML 2ML-1MG

Facility OP

$0.03

Hospital Charge Code	41648035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

ALCOHOL AND/O DRUG ASSESS

Facility OP

$20.00

Service Code	HCPCS H0001
Hospital Charge Code	30305704
Hospital Revenue Code	900
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$18,861.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$99.45
Rate for Payer: Aetna Government	$99.45
Rate for Payer: Amida Care Medicaid	$188.61
Rate for Payer: Carelon Behavioral Health HARP/QHP	$190.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,861.00
Rate for Payer: Fidelis Essential Plan Aliesa	$188.61
Rate for Payer: Fidelis Essential Plan QHP	$188.61
Rate for Payer: Fidelis Qualified Health Plan	$198.04
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	$188.61
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$188.61
Rate for Payer: Healthfirst Essential Plan	$424.37
Rate for Payer: Healthfirst QHP	$188.61
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$190.33
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$428.24
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$428.24
Rate for Payer: Optum Medicaid	$190.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$188.61
Rate for Payer: SOMOS Essential	$424.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$188.61

Price Transparency.

All Charges