St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC OT UNLISTED OT PROCEDURE

Facility

$70.00

Service Code	CPT 97799 GO
Hospital Charge Code	4309779901
Hospital Revenue Code	430
Min. Negotiated Rate	$31.91
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.00
Rate for Payer: Aetna Government	$35.00
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	$35.00
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	$35.00
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 UNLISTED THER.PROCEDURE 15MIN

Facility

$31.00

Service Code	CPT 97139 GO
Hospital Charge Code	4309713901
Hospital Revenue Code	430
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.91
Rate for Payer: Aetna Government	$14.91
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	$15.50
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	$15.50
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 UNLISTED THER.PROCEDURE 15MIN

Facility

$31.00

Service Code	CPT 97139 GO
Hospital Charge Code	4309713901
Hospital Revenue Code	430
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$15.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.50

HC OT VASOPNEUMATIC DEVICE THERAPY

Facility

$35.00

Service Code	CPT 97016 GO
Hospital Charge Code	4309701601
Hospital Revenue Code	430
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50

HC OT VASOPNEUMATIC DEVICE THERAPY

Facility

$35.00

Service Code	CPT 97016 GO
Hospital Charge Code	4309701601
Hospital Revenue Code	430
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.69
Rate for Payer: Aetna Government	$11.69
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	$17.50
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	$17.50
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 WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN

Facility

$96.00

Service Code	CPT 97542 GO
Hospital Charge Code	4309754201
Hospital Revenue Code	430
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00

HC OT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN

Facility

$96.00

Service Code	CPT 97542 GO
Hospital Charge Code	4309754201
Hospital Revenue Code	430
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.52
Rate for Payer: Aetna Government	$18.52
Rate for Payer: Affinity Essential Plan 1&2	$135.54
Rate for Payer: Affinity Essential Plan 3&4	$135.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$60.24
Rate for Payer: Amida Care Medicaid	$60.24
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	$48.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$135.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$60.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60.24
Rate for Payer: Fidelis Essential Plan Aliesa	$135.54
Rate for Payer: Fidelis Essential Plan QHP	$135.54
Rate for Payer: Fidelis Qualified Health Plan	$63.25
Rate for Payer: Group Health Inc Commercial	$48.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.24
Rate for Payer: Hamaspik Choice Inc Medicare	$60.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.24
Rate for Payer: Healthfirst Essential Plan	$135.54
Rate for Payer: Healthfirst QHP	$98.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.24
Rate for Payer: SOMOS Essential	$135.54
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$135.54
Rate for Payer: United Healthcare Essential Plan 3&4	$66.26
Rate for Payer: United Healthcare Medicaid	$60.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60.24
Rate for Payer: Wellcare Medicare	$55.00

HC OT WHIRLPOOL THERAPY

Facility

$53.00

Service Code	CPT 97022 GO
Hospital Charge Code	4309702201
Hospital Revenue Code	430
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.37
Rate for Payer: Aetna Government	$14.37
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	$26.50
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	$26.50
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 WHIRLPOOL THERAPY

Facility

$53.00

Service Code	CPT 97022 GO
Hospital Charge Code	4309702201
Hospital Revenue Code	430
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$26.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.50

HC OT WOUND DEBRIDEMNT, NON-SELECTIVE, EA

Facility

$529.00

Service Code	CPT 97602 GO
Hospital Charge Code	4309760201
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 WOUND DEBRIDEMNT, NON-SELECTIVE, EA

Facility

$529.00

Service Code	CPT 97602 GO
Hospital Charge Code	4309760201
Hospital Revenue Code	430
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$290.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.66
Rate for Payer: Aetna Government	$32.66
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 OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING

Facility

$333.00

Service Code	CPT 93798
Hospital Charge Code	9439379801
Hospital Revenue Code	943
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$266.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$183.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.84
Rate for Payer: Aetna Government	$153.84
Rate for Payer: Affinity Essential Plan 1&2	$107.69
Rate for Payer: Affinity Essential Plan 3&4	$107.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.69
Rate for Payer: Brighton Health Commercial	$249.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$153.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$266.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$226.44
Rate for Payer: Elderplan Medicare Advantage	$153.84
Rate for Payer: EmblemHealth Commercial	$153.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$138.46
Rate for Payer: Fidelis Essential Plan Aliesa	$130.76
Rate for Payer: Fidelis Essential Plan QHP	$136.92
Rate for Payer: Fidelis Medicare Advantage	$153.84
Rate for Payer: Fidelis Qualified Health Plan	$136.92
Rate for Payer: Group Health Inc Commercial	$153.84
Rate for Payer: Group Health Inc Medicare	$153.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.84
Rate for Payer: Hamaspik Choice Inc Medicare	$153.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.76
Rate for Payer: Healthfirst Medicare Advantage	$130.76
Rate for Payer: Healthfirst QHP	$153.84
Rate for Payer: Humana Medicare	$156.92
Rate for Payer: Senior Whole Health Medicare Advantage	$153.84
Rate for Payer: United Healthcare Commercial	$166.50
Rate for Payer: United Healthcare Medicare Advantage	$153.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$153.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.15
Rate for Payer: Wellcare Medicare	$146.15

HC OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING

Facility

$333.00

Service Code	CPT 93798
Hospital Charge Code	9439379801
Hospital Revenue Code	943
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$166.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.50

HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION

Facility

$22.00

Service Code	CPT 87177
Hospital Charge Code	3068717701
Hospital Revenue Code	306
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$20.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.90
Rate for Payer: Aetna Government	$8.90
Rate for Payer: Affinity Essential Plan 1&2	$6.23
Rate for Payer: Affinity Essential Plan 3&4	$6.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.23
Rate for Payer: Brighton Health Commercial	$16.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.73
Rate for Payer: Elderplan Medicare Advantage	$8.90
Rate for Payer: EmblemHealth Commercial	$8.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.01
Rate for Payer: Fidelis Essential Plan Aliesa	$7.57
Rate for Payer: Fidelis Essential Plan QHP	$7.92
Rate for Payer: Fidelis Medicare Advantage	$8.90
Rate for Payer: Fidelis Qualified Health Plan	$7.92
Rate for Payer: Group Health Inc Commercial	$8.90
Rate for Payer: Group Health Inc Medicare	$8.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.90
Rate for Payer: Hamaspik Choice Inc Medicare	$8.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.90
Rate for Payer: Healthfirst Essential Plan	$20.02
Rate for Payer: Healthfirst Medicare Advantage	$8.90
Rate for Payer: Healthfirst QHP	$8.90
Rate for Payer: Humana Medicare	$9.08
Rate for Payer: Senior Whole Health Medicare Advantage	$8.90
Rate for Payer: United Healthcare Commercial	$11.27
Rate for Payer: United Healthcare Medicare Advantage	$8.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.90
Rate for Payer: Wellcare Medicare	$8.01

HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION

Facility

$22.00

Service Code	CPT 87177
Hospital Charge Code	3068717701
Hospital Revenue Code	306
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$11.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.00

HC PACU PHASE 1

Facility

$312.00

Hospital Charge Code	7100000001
Hospital Revenue Code	710
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$249.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.00
Rate for Payer: Aetna Government	$156.00
Rate for Payer: Brighton Health Commercial	$234.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$249.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.16
Rate for Payer: EmblemHealth Commercial	$156.00
Rate for Payer: Group Health Inc Commercial	$156.00
Rate for Payer: Group Health Inc Medicare	$109.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00
Rate for Payer: Hamaspik Choice Inc Medicare	$156.00

HC PACU PHASE 1

Facility

$312.00

Hospital Charge Code	7100000001
Hospital Revenue Code	710
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$156.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.00

HC PACU PHASE 1 ADD'L 1/2 HOUR

Facility

$206.00

Hospital Charge Code	7100000002
Hospital Revenue Code	710
Min. Negotiated Rate	$103.00
Max. Negotiated Rate	$103.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.00

HC PACU PHASE 1 ADD'L 1/2 HOUR

Facility

$206.00

Hospital Charge Code	7100000002
Hospital Revenue Code	710
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$164.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$113.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.00
Rate for Payer: Aetna Government	$103.00
Rate for Payer: Brighton Health Commercial	$154.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.08
Rate for Payer: EmblemHealth Commercial	$103.00
Rate for Payer: Group Health Inc Commercial	$103.00
Rate for Payer: Group Health Inc Medicare	$72.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.00
Rate for Payer: Hamaspik Choice Inc Medicare	$103.00

HC PACU PHASE 2

Facility

$250.00

Hospital Charge Code	7100000009
Hospital Revenue Code	710
Min. Negotiated Rate	$125.00
Max. Negotiated Rate	$125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00

HC PACU PHASE 2

Facility

$250.00

Hospital Charge Code	7100000009
Hospital Revenue Code	710
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.00
Rate for Payer: Aetna Government	$125.00
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$170.00
Rate for Payer: EmblemHealth Commercial	$125.00
Rate for Payer: Group Health Inc Commercial	$125.00
Rate for Payer: Group Health Inc Medicare	$87.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$125.00

HC PACU PHASE 2 ADD'L 1/2 HOUR

Facility

$165.00

Hospital Charge Code	7100000010
Hospital Revenue Code	710
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.50

HC PACU PHASE 2 ADD'L 1/2 HOUR

Facility

$165.00

Hospital Charge Code	7100000010
Hospital Revenue Code	710
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$132.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$82.50
Rate for Payer: Aetna Government	$82.50
Rate for Payer: Brighton Health Commercial	$123.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$132.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.20
Rate for Payer: EmblemHealth Commercial	$82.50
Rate for Payer: Group Health Inc Commercial	$82.50
Rate for Payer: Group Health Inc Medicare	$57.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.50
Rate for Payer: Hamaspik Choice Inc Medicare	$82.50

HC PAIR OR CUT OF BENIGN HYPERKERATOTIC LESION, 2-4 LESIONS

Facility

$529.00

Service Code	CPT 11056
Hospital Charge Code	3611105601
Hospital Revenue Code	361
Min. Negotiated Rate	$24.35
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.78
Rate for Payer: Aetna Government	$242.78
Rate for Payer: Affinity Essential Plan 1&2	$169.95
Rate for Payer: Affinity Essential Plan 3&4	$169.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.95
Rate for Payer: Brighton Health Commercial	$396.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$242.78
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	$242.78
Rate for Payer: EmblemHealth Commercial	$242.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$218.50
Rate for Payer: Fidelis Essential Plan Aliesa	$206.36
Rate for Payer: Fidelis Essential Plan QHP	$216.07
Rate for Payer: Fidelis Medicare Advantage	$242.78
Rate for Payer: Fidelis Qualified Health Plan	$216.07
Rate for Payer: Group Health Inc Commercial	$242.78
Rate for Payer: Group Health Inc Medicare	$242.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.78
Rate for Payer: Hamaspik Choice Inc Medicare	$242.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24.35
Rate for Payer: Healthfirst Medicare Advantage	$206.36
Rate for Payer: Healthfirst QHP	$242.78
Rate for Payer: Humana Medicare	$247.64
Rate for Payer: Senior Whole Health Medicare Advantage	$242.78
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$242.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$242.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$230.64
Rate for Payer: Wellcare Medicare	$230.64

HC PAIR OR CUT OF BENIGN HYPERKERATOTIC LESION, 2-4 LESIONS

Facility

$529.00

Service Code	CPT 11056
Hospital Charge Code	3611105601
Hospital Revenue Code	361
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

Know your out-of-pocket cost for care.

All Charges