St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC OSTEOPLASTY-FOR ORTHOGNATHIC DEFO

Facility

$11,340.00

Service Code	CPT D7940
Hospital Charge Code	361D794001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,422.00
Max. Negotiated Rate	$9,072.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,237.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,031.43
Rate for Payer: Aetna Government	$2,031.43
Rate for Payer: Affinity Essential Plan 1&2	$1,422.00
Rate for Payer: Affinity Essential Plan 3&4	$1,422.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,422.00
Rate for Payer: Brighton Health Commercial	$8,505.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,031.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,072.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,711.20
Rate for Payer: Elderplan Medicare Advantage	$2,031.43
Rate for Payer: EmblemHealth Commercial	$2,031.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,828.29
Rate for Payer: Fidelis Essential Plan Aliesa	$1,726.72
Rate for Payer: Fidelis Essential Plan QHP	$1,807.97
Rate for Payer: Fidelis Medicare Advantage	$2,031.43
Rate for Payer: Fidelis Qualified Health Plan	$1,807.97
Rate for Payer: Group Health Inc Commercial	$2,031.43
Rate for Payer: Group Health Inc Medicare	$2,031.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,031.43
Rate for Payer: Hamaspik Choice Inc Medicare	$2,031.43
Rate for Payer: Healthfirst Medicare Advantage	$1,726.72
Rate for Payer: Healthfirst QHP	$2,031.43
Rate for Payer: Humana Medicare	$2,072.06
Rate for Payer: Senior Whole Health Medicare Advantage	$2,031.43
Rate for Payer: United Healthcare Medicare Advantage	$2,031.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,031.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,929.86
Rate for Payer: Wellcare Medicare	$1,929.86

HC OSTEOPLASTY-FOR ORTHOGNATHIC DEFO

Facility

$11,340.00

Service Code	CPT D7940
Hospital Charge Code	361D794001
Hospital Revenue Code	361
Min. Negotiated Rate	$5,670.00
Max. Negotiated Rate	$5,670.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,670.00

HC OSTEOTOMY-BODY OF MANDIE

Facility

$2,755.00

Service Code	CPT D7945
Hospital Charge Code	361D794501
Hospital Revenue Code	361
Min. Negotiated Rate	$964.25
Max. Negotiated Rate	$2,460.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,515.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,460.81
Rate for Payer: Aetna Government	$2,460.81
Rate for Payer: Brighton Health Commercial	$2,066.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,204.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,873.40
Rate for Payer: EmblemHealth Commercial	$1,377.50
Rate for Payer: Group Health Inc Commercial	$1,377.50
Rate for Payer: Group Health Inc Medicare	$964.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,377.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,377.50

HC OSTEOTOMY-BODY OF MANDIE

Facility

$2,755.00

Service Code	CPT D7945
Hospital Charge Code	361D794501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,377.50
Max. Negotiated Rate	$1,377.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,377.50

HC OSTEOTOMY-RAMUS, CLOSED

Facility

$3,625.00

Service Code	CPT D7941
Hospital Charge Code	361D794101
Hospital Revenue Code	361
Min. Negotiated Rate	$1,812.50
Max. Negotiated Rate	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,812.50

HC OSTEOTOMY-RAMUS, CLOSED

Facility

$3,625.00

Service Code	CPT D7941
Hospital Charge Code	361D794101
Hospital Revenue Code	361
Min. Negotiated Rate	$1,268.75
Max. Negotiated Rate	$2,900.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,993.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,258.73
Rate for Payer: Aetna Government	$2,258.73
Rate for Payer: Brighton Health Commercial	$2,718.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,465.00
Rate for Payer: EmblemHealth Commercial	$1,812.50
Rate for Payer: Group Health Inc Commercial	$1,812.50
Rate for Payer: Group Health Inc Medicare	$1,268.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,812.50

HC OT COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN

Facility

$95.00

Service Code	CPT 97537 GO
Hospital Charge Code	4309753701
Hospital Revenue Code	430
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$47.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.50

HC OT COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN

Facility

$95.00

Service Code	CPT 97537 GO
Hospital Charge Code	4309753701
Hospital Revenue Code	430
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.08
Rate for Payer: Aetna Government	$18.08
Rate for Payer: Affinity Essential Plan 1&2	$125.70
Rate for Payer: Affinity Essential Plan 3&4	$125.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$55.87
Rate for Payer: Amida Care Medicaid	$55.87
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$47.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$125.70
Rate for Payer: EmblemHealth Essential Plan 3&4	$55.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55.87
Rate for Payer: Fidelis Essential Plan Aliesa	$125.70
Rate for Payer: Fidelis Essential Plan QHP	$125.70
Rate for Payer: Fidelis Qualified Health Plan	$58.66
Rate for Payer: Group Health Inc Commercial	$47.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.87
Rate for Payer: Hamaspik Choice Inc Medicare	$55.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55.87
Rate for Payer: Healthfirst Essential Plan	$125.70
Rate for Payer: Healthfirst QHP	$91.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.87
Rate for Payer: SOMOS Essential	$125.70
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$125.70
Rate for Payer: United Healthcare Essential Plan 3&4	$61.45
Rate for Payer: United Healthcare Medicaid	$55.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55.87
Rate for Payer: Wellcare Medicare	$55.00

HC OT CONTRAST BATH THERAPY

Facility

$44.00

Service Code	CPT 97034 GO
Hospital Charge Code	4309703401
Hospital Revenue Code	430
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.95
Rate for Payer: Aetna Government	$10.95
Rate for Payer: Affinity Essential Plan 1&2	$71.81
Rate for Payer: Affinity Essential Plan 3&4	$71.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.91
Rate for Payer: Amida Care Medicaid	$31.91
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$22.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$71.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$31.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.91
Rate for Payer: Fidelis Essential Plan Aliesa	$71.81
Rate for Payer: Fidelis Essential Plan QHP	$71.81
Rate for Payer: Fidelis Qualified Health Plan	$33.51
Rate for Payer: Group Health Inc Commercial	$22.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.91
Rate for Payer: Hamaspik Choice Inc Medicare	$31.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.91
Rate for Payer: Healthfirst Essential Plan	$71.81
Rate for Payer: Healthfirst QHP	$52.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.91
Rate for Payer: SOMOS Essential	$71.81
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$71.81
Rate for Payer: United Healthcare Essential Plan 3&4	$35.11
Rate for Payer: United Healthcare Medicaid	$31.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.91
Rate for Payer: Wellcare Medicare	$55.00

HC OT CONTRAST BATH THERAPY

Facility

$44.00

Service Code	CPT 97034 GO
Hospital Charge Code	4309703401
Hospital Revenue Code	430
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00

HC OT DEBRIDEMENT OPEN WOUND 20 SQ CM<

Facility

$529.00

Service Code	CPT 97597 GO
Hospital Charge Code	4309759701
Hospital Revenue Code	430
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

HC OT DEBRIDEMENT OPEN WOUND 20 SQ CM<

Facility

$529.00

Service Code	CPT 97597 GO
Hospital Charge Code	4309759701
Hospital Revenue Code	430
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$290.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$66.09
Rate for Payer: Aetna Government	$66.09
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$264.50
Rate for Payer: Group Health Inc Commercial	$264.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50
Rate for Payer: Hamaspik Choice Inc Medicare	$264.50
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

HC OT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM

Facility

$529.00

Service Code	CPT 97598 GO
Hospital Charge Code	4309759801
Hospital Revenue Code	430
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

HC OT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM

Facility

$529.00

Service Code	CPT 97598 GO
Hospital Charge Code	4309759801
Hospital Revenue Code	430
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$290.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.33
Rate for Payer: Aetna Government	$21.33
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$264.50
Rate for Payer: Group Health Inc Commercial	$264.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50
Rate for Payer: Hamaspik Choice Inc Medicare	$264.50
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

HC OT DIATHERMY TREATMENT

Facility

$21.00

Service Code	CPT 97024 GO
Hospital Charge Code	4309702401
Hospital Revenue Code	430
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.50

HC OT DIATHERMY TREATMENT

Facility

$21.00

Service Code	CPT 97024 GO
Hospital Charge Code	4309702401
Hospital Revenue Code	430
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.97
Rate for Payer: Aetna Government	$3.97
Rate for Payer: Affinity Essential Plan 1&2	$71.81
Rate for Payer: Affinity Essential Plan 3&4	$71.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.91
Rate for Payer: Amida Care Medicaid	$31.91
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$10.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$71.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$31.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.91
Rate for Payer: Fidelis Essential Plan Aliesa	$71.81
Rate for Payer: Fidelis Essential Plan QHP	$71.81
Rate for Payer: Fidelis Qualified Health Plan	$33.51
Rate for Payer: Group Health Inc Commercial	$10.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.91
Rate for Payer: Hamaspik Choice Inc Medicare	$31.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.91
Rate for Payer: Healthfirst Essential Plan	$71.81
Rate for Payer: Healthfirst QHP	$52.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.91
Rate for Payer: SOMOS Essential	$71.81
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$71.81
Rate for Payer: United Healthcare Essential Plan 3&4	$35.11
Rate for Payer: United Healthcare Medicaid	$31.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.91
Rate for Payer: Wellcare Medicare	$55.00

HC OT ELECTRICAL STIMULATION

Facility

$42.00

Service Code	CPT 97032 GO
Hospital Charge Code	4309703201
Hospital Revenue Code	430
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00

HC OT ELECTRICAL STIMULATION

Facility

$42.00

Service Code	CPT 97032 GO
Hospital Charge Code	4309703201
Hospital Revenue Code	430
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Affinity Essential Plan 1&2	$71.81
Rate for Payer: Affinity Essential Plan 3&4	$71.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.91
Rate for Payer: Amida Care Medicaid	$31.91
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$21.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$71.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$31.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.91
Rate for Payer: Fidelis Essential Plan Aliesa	$71.81
Rate for Payer: Fidelis Essential Plan QHP	$71.81
Rate for Payer: Fidelis Qualified Health Plan	$33.51
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.91
Rate for Payer: Hamaspik Choice Inc Medicare	$31.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.91
Rate for Payer: Healthfirst Essential Plan	$71.81
Rate for Payer: Healthfirst QHP	$52.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.91
Rate for Payer: SOMOS Essential	$71.81
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$71.81
Rate for Payer: United Healthcare Essential Plan 3&4	$35.11
Rate for Payer: United Healthcare Medicaid	$31.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.91
Rate for Payer: Wellcare Medicare	$55.00

HC OT ELECTRIC CURRENT THERAPY

Facility

$60.00

Service Code	CPT 97033 GO
Hospital Charge Code	4309703301
Hospital Revenue Code	430
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00

HC OT ELECTRIC CURRENT THERAPY

Facility

$60.00

Service Code	CPT 97033 GO
Hospital Charge Code	4309703301
Hospital Revenue Code	430
Min. Negotiated Rate	$15.94
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.94
Rate for Payer: Aetna Government	$15.94
Rate for Payer: Affinity Essential Plan 1&2	$71.81
Rate for Payer: Affinity Essential Plan 3&4	$71.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.91
Rate for Payer: Amida Care Medicaid	$31.91
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$71.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$31.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.91
Rate for Payer: Fidelis Essential Plan Aliesa	$71.81
Rate for Payer: Fidelis Essential Plan QHP	$71.81
Rate for Payer: Fidelis Qualified Health Plan	$33.51
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.91
Rate for Payer: Hamaspik Choice Inc Medicare	$31.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.91
Rate for Payer: Healthfirst Essential Plan	$71.81
Rate for Payer: Healthfirst QHP	$52.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.91
Rate for Payer: SOMOS Essential	$71.81
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$71.81
Rate for Payer: United Healthcare Essential Plan 3&4	$35.11
Rate for Payer: United Healthcare Medicaid	$31.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.91
Rate for Payer: Wellcare Medicare	$55.00

HC OT ELECTRIC STIMULATION THERAPY

Facility

$32.00

Service Code	CPT 97014 GO
Hospital Charge Code	4309701401
Hospital Revenue Code	430
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.69
Rate for Payer: Aetna Government	$9.69
Rate for Payer: Affinity Essential Plan 1&2	$71.81
Rate for Payer: Affinity Essential Plan 3&4	$71.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.91
Rate for Payer: Amida Care Medicaid	$31.91
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$16.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$71.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$31.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.91
Rate for Payer: Fidelis Essential Plan Aliesa	$71.81
Rate for Payer: Fidelis Essential Plan QHP	$71.81
Rate for Payer: Fidelis Qualified Health Plan	$33.51
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.91
Rate for Payer: Hamaspik Choice Inc Medicare	$31.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31.91
Rate for Payer: Healthfirst Essential Plan	$71.81
Rate for Payer: Healthfirst QHP	$52.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.91
Rate for Payer: SOMOS Essential	$71.81
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$71.81
Rate for Payer: United Healthcare Essential Plan 3&4	$35.11
Rate for Payer: United Healthcare Medicaid	$31.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.91
Rate for Payer: Wellcare Medicare	$55.00

HC OT ELECTRIC STIMULATION THERAPY

Facility

$32.00

Service Code	CPT 97014 GO
Hospital Charge Code	4309701401
Hospital Revenue Code	430
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

HC OT GAIT TRAINING THERAPY

Facility

$88.00

Service Code	CPT 97116 GO
Hospital Charge Code	4309711601
Hospital Revenue Code	430
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$44.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.00

HC OT GAIT TRAINING THERAPY

Facility

$88.00

Service Code	CPT 97116 GO
Hospital Charge Code	4309711601
Hospital Revenue Code	430
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.96
Rate for Payer: Aetna Government	$16.96
Rate for Payer: Affinity Essential Plan 1&2	$118.52
Rate for Payer: Affinity Essential Plan 3&4	$118.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$52.67
Rate for Payer: Amida Care Medicaid	$52.67
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$44.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$118.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$52.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52.67
Rate for Payer: Fidelis Essential Plan Aliesa	$118.52
Rate for Payer: Fidelis Essential Plan QHP	$118.52
Rate for Payer: Fidelis Qualified Health Plan	$55.31
Rate for Payer: Group Health Inc Commercial	$44.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.67
Rate for Payer: Hamaspik Choice Inc Medicare	$52.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52.67
Rate for Payer: Healthfirst Essential Plan	$118.52
Rate for Payer: Healthfirst QHP	$85.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.67
Rate for Payer: SOMOS Essential	$118.52
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$118.52
Rate for Payer: United Healthcare Essential Plan 3&4	$57.94
Rate for Payer: United Healthcare Medicaid	$52.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52.67
Rate for Payer: Wellcare Medicare	$55.00

HC OT GROUP THERAPEUTIC PROCEDURES

Facility

$52.00

Service Code	CPT 97150 GO
Hospital Charge Code	4309715001
Hospital Revenue Code	430
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.34
Rate for Payer: Aetna Government	$10.34
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$26.00
Rate for Payer: Group Health Inc Commercial	$26.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26.00
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

Know your out-of-pocket cost for care.

All Charges