St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC PRGRMG EVAL IMPLANTABLE DFB - CARDIAC DEVICE CLINIC ICD BIV CHAMBER

Facility

$109.00

Service Code	CPT 93284
Hospital Charge Code	4809328404
Hospital Revenue Code	480
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.56
Rate for Payer: Aetna Government	$45.56
Rate for Payer: Affinity Essential Plan 1&2	$31.89
Rate for Payer: Affinity Essential Plan 3&4	$31.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.89
Rate for Payer: Brighton Health Commercial	$81.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$45.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.12
Rate for Payer: Elderplan Medicare Advantage	$45.56
Rate for Payer: EmblemHealth Commercial	$45.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41.00
Rate for Payer: Fidelis Essential Plan Aliesa	$38.73
Rate for Payer: Fidelis Essential Plan QHP	$40.55
Rate for Payer: Fidelis Medicare Advantage	$45.56
Rate for Payer: Fidelis Qualified Health Plan	$40.55
Rate for Payer: Group Health Inc Commercial	$45.56
Rate for Payer: Group Health Inc Medicare	$45.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.56
Rate for Payer: Hamaspik Choice Inc Medicare	$45.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$116.80
Rate for Payer: Healthfirst Medicare Advantage	$38.73
Rate for Payer: Healthfirst QHP	$45.56
Rate for Payer: Humana Medicare	$46.47
Rate for Payer: Senior Whole Health Medicare Advantage	$45.56
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$45.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.28
Rate for Payer: Wellcare Medicare	$43.28

HC PRGRMG EVAL IMPLANTABLE DFB - CARDIAC DEVICE CLINIC ICD BIV CHAMBER

Facility

$109.00

Service Code	CPT 93284
Hospital Charge Code	4809328404
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC PRGRMG EVAL IMPLANTABLE DFB - CRT DUAL DEFIB

Facility

$109.00

Service Code	CPT 93283
Hospital Charge Code	4809328303
Hospital Revenue Code	480
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.56
Rate for Payer: Aetna Government	$45.56
Rate for Payer: Affinity Essential Plan 1&2	$31.89
Rate for Payer: Affinity Essential Plan 3&4	$31.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.89
Rate for Payer: Brighton Health Commercial	$81.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$45.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.12
Rate for Payer: Elderplan Medicare Advantage	$45.56
Rate for Payer: EmblemHealth Commercial	$45.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41.00
Rate for Payer: Fidelis Essential Plan Aliesa	$38.73
Rate for Payer: Fidelis Essential Plan QHP	$40.55
Rate for Payer: Fidelis Medicare Advantage	$45.56
Rate for Payer: Fidelis Qualified Health Plan	$40.55
Rate for Payer: Group Health Inc Commercial	$45.56
Rate for Payer: Group Health Inc Medicare	$45.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.56
Rate for Payer: Hamaspik Choice Inc Medicare	$45.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$108.31
Rate for Payer: Healthfirst Medicare Advantage	$38.73
Rate for Payer: Healthfirst QHP	$45.56
Rate for Payer: Humana Medicare	$46.47
Rate for Payer: Senior Whole Health Medicare Advantage	$45.56
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$45.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.28
Rate for Payer: Wellcare Medicare	$43.28

HC PRGRMG EVAL IMPLANTABLE DFB - CRT DUAL DEFIB

Facility

$109.00

Service Code	CPT 93283
Hospital Charge Code	4809328303
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC PRGRMG EVAL IMPLANTABLE DFB - CRT SINGLE DEFIB

Facility

$122.00

Service Code	CPT 93282
Hospital Charge Code	4809328203
Hospital Revenue Code	480
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$61.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00

HC PRGRMG EVAL IMPLANTABLE DFB - CRT SINGLE DEFIB

Facility

$122.00

Service Code	CPT 93282
Hospital Charge Code	4809328203
Hospital Revenue Code	480
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.56
Rate for Payer: Aetna Government	$45.56
Rate for Payer: Affinity Essential Plan 1&2	$31.89
Rate for Payer: Affinity Essential Plan 3&4	$31.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$31.89
Rate for Payer: Brighton Health Commercial	$91.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$45.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$97.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.96
Rate for Payer: Elderplan Medicare Advantage	$45.56
Rate for Payer: EmblemHealth Commercial	$45.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41.00
Rate for Payer: Fidelis Essential Plan Aliesa	$38.73
Rate for Payer: Fidelis Essential Plan QHP	$40.55
Rate for Payer: Fidelis Medicare Advantage	$45.56
Rate for Payer: Fidelis Qualified Health Plan	$40.55
Rate for Payer: Group Health Inc Commercial	$45.56
Rate for Payer: Group Health Inc Medicare	$45.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.56
Rate for Payer: Hamaspik Choice Inc Medicare	$45.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$88.43
Rate for Payer: Healthfirst Medicare Advantage	$38.73
Rate for Payer: Healthfirst QHP	$45.56
Rate for Payer: Humana Medicare	$46.47
Rate for Payer: Senior Whole Health Medicare Advantage	$45.56
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$45.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$45.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.28
Rate for Payer: Wellcare Medicare	$43.28

HC PRIMATRIX, PER SQ CM

Facility

$69.00

Service Code	CPT Q4110
Hospital Charge Code	636Q411001
Hospital Revenue Code	636
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$34.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.50
Rate for Payer: Hamaspik Choice Inc Medicare	$34.50

HC PRIMATRIX, PER SQ CM

Facility

$69.00

Service Code	CPT Q4110
Hospital Charge Code	636Q411001
Hospital Revenue Code	636
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$65.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.43
Rate for Payer: Aetna Government	$43.43
Rate for Payer: Brighton Health Commercial	$41.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.67
Rate for Payer: EmblemHealth Commercial	$34.50
Rate for Payer: Group Health Inc Commercial	$34.50
Rate for Payer: Group Health Inc Medicare	$24.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.50
Rate for Payer: Hamaspik Choice Inc Medicare	$34.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$65.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.85

HC PRIM MCHNICL THRMBCTMY ART BYPASS GRAFT, ADD'L VESSEL

Facility

$2,552.00

Service Code	CPT 37185 TC
Hospital Charge Code	3613718501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,276.00
Max. Negotiated Rate	$1,276.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,276.00

HC PRIM MCHNICL THRMBCTMY ART BYPASS GRAFT, ADD'L VESSEL

Facility

$2,552.00

Service Code	CPT 37185 TC
Hospital Charge Code	3613718501
Hospital Revenue Code	361
Min. Negotiated Rate	$785.90
Max. Negotiated Rate	$3,387.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$785.90
Rate for Payer: Aetna Government	$785.90
Rate for Payer: Brighton Health Commercial	$1,914.00
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: EmblemHealth Commercial	$1,276.00
Rate for Payer: Group Health Inc Commercial	$1,276.00
Rate for Payer: Group Health Inc Medicare	$893.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,276.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,276.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC PRIM MCHNICL THRMBCTMY ART BYPASS GRAFT, FIRST VESSEL

Facility

$30,010.00

Service Code	CPT 37184 TC
Hospital Charge Code	3613718401
Hospital Revenue Code	361
Min. Negotiated Rate	$514.63
Max. Negotiated Rate	$22,507.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$514.63
Rate for Payer: Aetna Government	$514.63
Rate for Payer: Brighton Health Commercial	$22,507.50
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: EmblemHealth Commercial	$15,005.00
Rate for Payer: Group Health Inc Commercial	$15,005.00
Rate for Payer: Group Health Inc Medicare	$10,503.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,942.98
Rate for Payer: United Healthcare Commercial	$2,546.00

HC PRIM MCHNICL THRMBCTMY ART BYPASS GRAFT, FIRST VESSEL

Facility

$30,010.00

Service Code	CPT 37184 TC
Hospital Charge Code	3613718401
Hospital Revenue Code	361
Min. Negotiated Rate	$15,005.00
Max. Negotiated Rate	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00

HC PROBE NASOLACRIMAL DUCT

Facility

$5,861.00

Service Code	CPT 68811
Hospital Charge Code	5106881101
Hospital Revenue Code	510
Min. Negotiated Rate	$153.29
Max. Negotiated Rate	$2,992.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,850.46
Rate for Payer: Aetna Government	$2,850.46
Rate for Payer: Affinity Essential Plan 1&2	$1,995.32
Rate for Payer: Affinity Essential Plan 3&4	$1,995.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,995.32
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,850.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$2,850.46
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,565.41
Rate for Payer: Fidelis Essential Plan Aliesa	$2,422.89
Rate for Payer: Fidelis Essential Plan QHP	$2,536.91
Rate for Payer: Fidelis Medicare Advantage	$2,850.46
Rate for Payer: Fidelis Qualified Health Plan	$2,536.91
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,850.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1,026.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$153.29
Rate for Payer: Healthfirst Medicare Advantage	$2,422.89
Rate for Payer: Healthfirst QHP	$2,850.46
Rate for Payer: Humana Medicare	$2,907.47
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2,992.98
Rate for Payer: Senior Whole Health Medicare Advantage	$2,850.46
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$2,850.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,850.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,707.94
Rate for Payer: Wellcare Medicare	$2,707.94

HC PROBE NASOLACRIMAL DUCT

Facility

$5,861.00

Service Code	CPT 68811
Hospital Charge Code	5106881101
Hospital Revenue Code	510
Min. Negotiated Rate	$2,930.50
Max. Negotiated Rate	$2,930.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,930.50

HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID

Facility

$7,706.00

Service Code	CPT 45307
Hospital Charge Code	7504530701
Hospital Revenue Code	750
Min. Negotiated Rate	$120.21
Max. Negotiated Rate	$5,779.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,350.71
Rate for Payer: Aetna Government	$3,350.71
Rate for Payer: Affinity Essential Plan 1&2	$2,345.50
Rate for Payer: Affinity Essential Plan 3&4	$2,345.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,345.50
Rate for Payer: Brighton Health Commercial	$5,779.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,350.71
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	$3,350.71
Rate for Payer: EmblemHealth Commercial	$3,350.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,015.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2,848.10
Rate for Payer: Fidelis Essential Plan QHP	$2,982.13
Rate for Payer: Fidelis Medicare Advantage	$3,350.71
Rate for Payer: Fidelis Qualified Health Plan	$2,982.13
Rate for Payer: Group Health Inc Commercial	$3,350.71
Rate for Payer: Group Health Inc Medicare	$3,350.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,350.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1,397.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$120.21
Rate for Payer: Healthfirst Medicare Advantage	$2,848.10
Rate for Payer: Healthfirst QHP	$3,350.71
Rate for Payer: Humana Medicare	$3,417.72
Rate for Payer: Senior Whole Health Medicare Advantage	$3,350.71
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,350.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,350.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,183.17
Rate for Payer: Wellcare Medicare	$3,183.17

HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID

Facility

$7,706.00

Service Code	CPT 45307
Hospital Charge Code	7504530701
Hospital Revenue Code	750
Min. Negotiated Rate	$3,853.00
Max. Negotiated Rate	$3,853.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,853.00

HC PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS - ENDOSCOPY SIGMOID

Facility

$2,313.00

Service Code	CPT 45300
Hospital Charge Code	5104530001
Hospital Revenue Code	510
Min. Negotiated Rate	$1,156.50
Max. Negotiated Rate	$1,156.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,156.50

HC PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS - ENDOSCOPY SIGMOID

Facility

$2,313.00

Service Code	CPT 45300
Hospital Charge Code	5104530001
Hospital Revenue Code	510
Min. Negotiated Rate	$56.17
Max. Negotiated Rate	$1,169.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,113.95
Rate for Payer: Aetna Government	$1,113.95
Rate for Payer: Affinity Essential Plan 1&2	$779.76
Rate for Payer: Affinity Essential Plan 3&4	$779.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$779.76
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,113.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$1,113.95
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,002.55
Rate for Payer: Fidelis Essential Plan Aliesa	$946.86
Rate for Payer: Fidelis Essential Plan QHP	$991.42
Rate for Payer: Fidelis Medicare Advantage	$1,113.95
Rate for Payer: Fidelis Qualified Health Plan	$991.42
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,113.95
Rate for Payer: Hamaspik Choice Inc Medicare	$95.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$56.17
Rate for Payer: Healthfirst Medicare Advantage	$946.86
Rate for Payer: Healthfirst QHP	$1,113.95
Rate for Payer: Humana Medicare	$1,136.23
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,169.65
Rate for Payer: Senior Whole Health Medicare Advantage	$1,113.95
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,113.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,113.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,058.25
Rate for Payer: Wellcare Medicare	$1,058.25

HC PROF CONSULT (DIAG SERV BY OTHER

Facility

$75.00

Service Code	CPT D9310
Hospital Charge Code	361D931001
Hospital Revenue Code	361
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$97.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.31
Rate for Payer: Aetna Government	$58.31
Rate for Payer: Affinity Essential Plan 1&2	$97.64
Rate for Payer: Affinity Essential Plan 3&4	$97.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.39
Rate for Payer: Amida Care Medicaid	$43.39
Rate for Payer: Brighton Health Commercial	$56.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.00
Rate for Payer: EmblemHealth Commercial	$37.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$97.64
Rate for Payer: EmblemHealth Essential Plan 3&4	$43.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43.39
Rate for Payer: Fidelis Essential Plan Aliesa	$97.64
Rate for Payer: Fidelis Essential Plan QHP	$97.64
Rate for Payer: Fidelis Qualified Health Plan	$45.56
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.39
Rate for Payer: Hamaspik Choice Inc Medicare	$43.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.39
Rate for Payer: Healthfirst Essential Plan	$97.64
Rate for Payer: Healthfirst QHP	$70.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.39
Rate for Payer: SOMOS Essential	$97.64
Rate for Payer: United Healthcare Essential Plan 1&2	$97.64
Rate for Payer: United Healthcare Essential Plan 3&4	$47.73
Rate for Payer: United Healthcare Medicaid	$43.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.39

HC PROF CONSULT (DIAG SERV BY OTHER

Facility

$75.00

Service Code	CPT D9310
Hospital Charge Code	361D931001
Hospital Revenue Code	361
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50

HC PROGRAM INTAKE ASSESSMENT

Facility

$142.00

Service Code	CPT T1023
Hospital Charge Code	521T102301
Hospital Revenue Code	521
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00

HC PROGRAM INTAKE ASSESSMENT

Facility

$142.00

Service Code	CPT T1023
Hospital Charge Code	521T102301
Hospital Revenue Code	521
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Brighton Health Commercial	$106.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00
Rate for Payer: Hamaspik Choice Inc Medicare	$71.00

HC PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30

Facility

$162.00

Service Code	CPT 99355
Hospital Charge Code	5109935501
Hospital Revenue Code	510
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.00

HC PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30

Facility

$162.00

Service Code	CPT 99355
Hospital Charge Code	5109935501
Hospital Revenue Code	510
Min. Negotiated Rate	$67.05
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.05
Rate for Payer: Aetna Government	$67.05
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.00
Rate for Payer: Hamaspik Choice Inc Medicare	$81.00
Rate for Payer: United Healthcare Commercial	$222.00

HC PROLONGED OUTPATIENT EVAL AND MGMNT SERVICE EACH 15 MINS

Facility

$51.00

Service Code	CPT 99417
Hospital Charge Code	5109941701
Hospital Revenue Code	510
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.50

Know your out-of-pocket cost for care.

All Charges