St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC PTEN (PHOSPHATASE AND TENSIN HOMOLOG) FULL SEQUENCE

Facility

$136.00

Service Code	CPT 81321
Hospital Charge Code	3108132101
Hospital Revenue Code	310
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$612.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$600.00
Rate for Payer: Aetna Government	$600.00
Rate for Payer: Affinity Essential Plan 1&2	$420.00
Rate for Payer: Affinity Essential Plan 3&4	$420.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$420.00
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.48
Rate for Payer: Elderplan Medicare Advantage	$600.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$540.00
Rate for Payer: Fidelis Essential Plan Aliesa	$510.00
Rate for Payer: Fidelis Essential Plan QHP	$534.00
Rate for Payer: Fidelis Medicare Advantage	$600.00
Rate for Payer: Fidelis Qualified Health Plan	$534.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$600.00
Rate for Payer: Healthfirst Medicare Advantage	$600.00
Rate for Payer: Healthfirst QHP	$600.00
Rate for Payer: Humana Medicare	$612.00
Rate for Payer: Senior Whole Health Medicare Advantage	$600.00
Rate for Payer: United Healthcare Medicare Advantage	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$600.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$570.00
Rate for Payer: Wellcare Medicare	$540.00

HC PTEN (PHOSPHATASE AND TENSIN HOMOLOG) FULL SEQUENCE

Facility

$136.00

Service Code	CPT 81321
Hospital Charge Code	3108132101
Hospital Revenue Code	310
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$68.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00

HC PT GAIT TRAINING THERAPY

Facility

$88.00

Service Code	CPT 97116 GP
Hospital Charge Code	4209711601
Hospital Revenue Code	420
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 PT GAIT TRAINING THERAPY

Facility

$88.00

Service Code	CPT 97116 GP
Hospital Charge Code	4209711601
Hospital Revenue Code	420
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$44.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$44.00

HC PT GROUP THERAPEUTIC PROCEDURES

Facility

$52.00

Service Code	CPT 97150 GP
Hospital Charge Code	4209715001
Hospital Revenue Code	420
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

HC PT GROUP THERAPEUTIC PROCEDURES

Facility

$52.00

Service Code	CPT 97150 GP
Hospital Charge Code	4209715001
Hospital Revenue Code	420
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$26.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.00

HC PT HOT OR COLD PACKS THERAPY

Facility

$36.00

Service Code	CPT 97010 GP
Hospital Charge Code	4209701001
Hospital Revenue Code	420
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00

HC PT HOT OR COLD PACKS THERAPY

Facility

$36.00

Service Code	CPT 97010 GP
Hospital Charge Code	4209701001
Hospital Revenue Code	420
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.75
Rate for Payer: Aetna Government	$3.75
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	$18.00
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	$18.00
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 PT HYDROTHERAPY

Facility

$104.00

Service Code	CPT 97036 GP
Hospital Charge Code	4209703601
Hospital Revenue Code	420
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.11
Rate for Payer: Aetna Government	$20.11
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	$52.00
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	$52.00
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 PT HYDROTHERAPY

Facility

$104.00

Service Code	CPT 97036 GP
Hospital Charge Code	4209703601
Hospital Revenue Code	420
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00

HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN

Facility

$81.00

Service Code	CPT 97140 GP
Hospital Charge Code	4209714001
Hospital Revenue Code	420
Min. Negotiated Rate	$17.78
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.78
Rate for Payer: Aetna Government	$17.78
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	$40.50
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	$40.50
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 PT MANUAL THER TECH,1+REGIONS,EA 15 MIN

Facility

$81.00

Service Code	CPT 97140 GP
Hospital Charge Code	4209714001
Hospital Revenue Code	420
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.50

HC PT MASSAGE THERAPY

Facility

$85.00

Service Code	CPT 97124 GP
Hospital Charge Code	4209712401
Hospital Revenue Code	420
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$42.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.50

HC PT MASSAGE THERAPY

Facility

$85.00

Service Code	CPT 97124 GP
Hospital Charge Code	4209712401
Hospital Revenue Code	420
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.74
Rate for Payer: Aetna Government	$15.74
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	$42.50
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	$42.50
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 PT MECHANICAL TRACTION THERAPY

Facility

$43.00

Service Code	CPT 97012 GP
Hospital Charge Code	4209701201
Hospital Revenue Code	420
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.54
Rate for Payer: Aetna Government	$9.54
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	$21.50
Rate for Payer: Group Health Inc Commercial	$21.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50
Rate for Payer: Hamaspik Choice Inc Medicare	$21.50
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

HC PT MECHANICAL TRACTION THERAPY

Facility

$43.00

Service Code	CPT 97012 GP
Hospital Charge Code	4209701201
Hospital Revenue Code	420
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$21.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.50

HC PT NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM

Facility

$529.00

Service Code	CPT 97605 GP
Hospital Charge Code	4209760501
Hospital Revenue Code	420
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

HC PT NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM

Facility

$529.00

Service Code	CPT 97605 GP
Hospital Charge Code	4209760501
Hospital Revenue Code	420
Min. Negotiated Rate	$35.46
Max. Negotiated Rate	$290.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.46
Rate for Payer: Aetna Government	$35.46
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 PT NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM

Facility

$967.00

Service Code	CPT 97606 GP
Hospital Charge Code	4209760601
Hospital Revenue Code	420
Min. Negotiated Rate	$41.97
Max. Negotiated Rate	$531.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$531.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.97
Rate for Payer: Aetna Government	$41.97
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	$483.50
Rate for Payer: Group Health Inc Commercial	$483.50
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50
Rate for Payer: Hamaspik Choice Inc Medicare	$483.50
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

HC PT NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM

Facility

$967.00

Service Code	CPT 97606 GP
Hospital Charge Code	4209760601
Hospital Revenue Code	420
Min. Negotiated Rate	$483.50
Max. Negotiated Rate	$483.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50

HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN

Facility

$102.00

Service Code	CPT 97112 GP
Hospital Charge Code	4209711201
Hospital Revenue Code	420
Min. Negotiated Rate	$20.29
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.29
Rate for Payer: Aetna Government	$20.29
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	$51.00
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	$51.00
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 PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN

Facility

$102.00

Service Code	CPT 97112 GP
Hospital Charge Code	4209711201
Hospital Revenue Code	420
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC PT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN

Facility

$145.00

Service Code	CPT 97760 GP
Hospital Charge Code	4209776001
Hospital Revenue Code	420
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$72.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.50

HC PT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN

Facility

$145.00

Service Code	CPT 97760 GP
Hospital Charge Code	4209776001
Hospital Revenue Code	420
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.95
Rate for Payer: Aetna Government	$22.95
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	$72.50
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	$72.50
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 PT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN

Facility

$156.00

Service Code	CPT 97763 GP
Hospital Charge Code	4209776301
Hospital Revenue Code	420
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.00

Know your out-of-pocket cost for care.

All Charges