St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Hand & wrist procedures

Facility

$74,004.98

Service Code	APR-DRG 3164
Min. Negotiated Rate	$20,488.00
Max. Negotiated Rate	$74,004.98
Rate for Payer: Affinity Essential Plan 1&2	$74,004.98
Rate for Payer: Affinity Essential Plan 3&4	$74,004.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,891.10
Rate for Payer: Amida Care Medicaid	$32,891.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$74,004.98
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,891.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,891.10
Rate for Payer: Fidelis Qualified Health Plan	$39,469.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,891.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,891.10
Rate for Payer: Healthfirst Commercial	$36,562.00
Rate for Payer: Healthfirst Essential Plan	$74,004.98
Rate for Payer: Healthfirst QHP	$20,488.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,891.10
Rate for Payer: SOMOS Essential	$74,004.98
Rate for Payer: United Healthcare Essential Plan 1&2	$74,004.98
Rate for Payer: United Healthcare Essential Plan 3&4	$74,004.98
Rate for Payer: United Healthcare Medicaid	$32,891.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,891.10

Hand & wrist procedures

Facility

$69,532.49

Service Code	APR-DRG 3163
Min. Negotiated Rate	$20,327.00
Max. Negotiated Rate	$69,532.49
Rate for Payer: Affinity Essential Plan 1&2	$69,532.49
Rate for Payer: Affinity Essential Plan 3&4	$69,532.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,903.33
Rate for Payer: Amida Care Medicaid	$30,903.33
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,532.49
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,903.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,903.33
Rate for Payer: Fidelis Qualified Health Plan	$37,084.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,903.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,903.33
Rate for Payer: Healthfirst Commercial	$36,156.00
Rate for Payer: Healthfirst Essential Plan	$69,532.49
Rate for Payer: Healthfirst QHP	$20,327.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,903.33
Rate for Payer: SOMOS Essential	$69,532.49
Rate for Payer: United Healthcare Essential Plan 1&2	$69,532.49
Rate for Payer: United Healthcare Essential Plan 3&4	$69,532.49
Rate for Payer: United Healthcare Medicaid	$30,903.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,903.33

HB ABLTJ 1/+THYR NDUL 1LOBE PRQ

Facility

$4,793.00

Service Code	CPT 60660
Hospital Charge Code	3616066001
Hospital Revenue Code	361
Min. Negotiated Rate	$366.71
Max. Negotiated Rate	$3,594.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,636.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,979.64
Rate for Payer: Aetna Government	$1,979.64
Rate for Payer: Affinity Essential Plan 1&2	$1,385.75
Rate for Payer: Affinity Essential Plan 3&4	$1,385.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,385.75
Rate for Payer: Brighton Health Commercial	$3,594.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,979.64
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	$1,979.64
Rate for Payer: EmblemHealth Commercial	$1,979.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,781.68
Rate for Payer: Fidelis Essential Plan Aliesa	$1,682.69
Rate for Payer: Fidelis Essential Plan QHP	$1,761.88
Rate for Payer: Fidelis Medicare Advantage	$1,979.64
Rate for Payer: Fidelis Qualified Health Plan	$1,761.88
Rate for Payer: Group Health Inc Commercial	$1,979.64
Rate for Payer: Group Health Inc Medicare	$1,979.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,979.64
Rate for Payer: Hamaspik Choice Inc Medicare	$708.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$366.71
Rate for Payer: Healthfirst Medicare Advantage	$1,682.69
Rate for Payer: Healthfirst QHP	$1,979.64
Rate for Payer: Humana Medicare	$2,019.23
Rate for Payer: Senior Whole Health Medicare Advantage	$1,979.64
Rate for Payer: United Healthcare Medicare Advantage	$1,979.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,979.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,880.66
Rate for Payer: Wellcare Medicare	$1,880.66

HB ABLTJ 1/+THYR NDUL 1LOBE PRQ

Facility

$4,793.00

Service Code	CPT 60660
Hospital Charge Code	3616066001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,396.50
Max. Negotiated Rate	$2,396.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,396.50

HB ABLTJ 1/+THYR NDUL ADDL PRQ

Facility

$3,195.00

Service Code	CPT 60661
Hospital Charge Code	3616066101
Hospital Revenue Code	361
Min. Negotiated Rate	$1,597.50
Max. Negotiated Rate	$1,597.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,597.50

HB ABLTJ 1/+THYR NDUL ADDL PRQ

Facility

$3,195.00

Service Code	CPT 60661
Hospital Charge Code	3616066101
Hospital Revenue Code	361
Min. Negotiated Rate	$253.25
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,757.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,597.50
Rate for Payer: Aetna Government	$1,597.50
Rate for Payer: Brighton Health Commercial	$2,396.25
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	$1,597.50
Rate for Payer: Group Health Inc Commercial	$1,597.50
Rate for Payer: Group Health Inc Medicare	$1,118.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,597.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,597.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$253.25

HB ADMIN OF RESPIRATORY SYNCYTIAL VIRUS W/ COUNSELING BY HEATH CARE PROFESSIONAL

Facility

$193.00

Service Code	CPT 96380
Hospital Charge Code	7719638001
Hospital Revenue Code	771
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$96.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.50

HB ADMIN OF RESPIRATORY SYNCYTIAL VIRUS W/ COUNSELING BY HEATH CARE PROFESSIONAL

Facility

$193.00

Service Code	CPT 96380
Hospital Charge Code	7719638001
Hospital Revenue Code	771
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.50
Rate for Payer: Aetna Government	$96.50
Rate for Payer: Brighton Health Commercial	$144.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$131.24
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	$96.50
Rate for Payer: Hamaspik Choice Inc Medicare	$96.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.96
Rate for Payer: United Healthcare Commercial	$44.00

HB ADMIN OF RESP SYNCYTIAL VIRUS SEASONAL DOSE

Facility

$183.00

Service Code	CPT 96381
Hospital Charge Code	7719638101
Hospital Revenue Code	771
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.50

HB ADMIN OF RESP SYNCYTIAL VIRUS SEASONAL DOSE

Facility

$183.00

Service Code	CPT 96381
Hospital Charge Code	7719638101
Hospital Revenue Code	771
Min. Negotiated Rate	$22.39
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.50
Rate for Payer: Aetna Government	$91.50
Rate for Payer: Brighton Health Commercial	$137.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$146.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.44
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	$91.50
Rate for Payer: Hamaspik Choice Inc Medicare	$91.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22.39
Rate for Payer: United Healthcare Commercial	$44.00

HB ANTICOAGULANT MGMT FOR PT TAKING WARFARIN

Facility

$25.00

Service Code	CPT 93793
Hospital Charge Code	5109379301
Hospital Revenue Code	510
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.47
Rate for Payer: Aetna Government	$10.47
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	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.64
Rate for Payer: United Healthcare Commercial	$222.00

HB ANTICOAGULANT MGMT FOR PT TAKING WARFARIN

Facility

$25.00

Service Code	CPT 93793
Hospital Charge Code	5109379301
Hospital Revenue Code	510
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50

HB AQUAPORIN-4 ANTBDY CELL-BASED IMFLUOR ASSAY EACH

Facility

$72.00

Service Code	CPT 86052
Hospital Charge Code	3018605201
Hospital Revenue Code	301
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00

HB AQUAPORIN-4 ANTBDY CELL-BASED IMFLUOR ASSAY EACH

Facility

$72.00

Service Code	CPT 86052
Hospital Charge Code	3018605201
Hospital Revenue Code	301
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$57.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$54.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.96
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.30
Rate for Payer: Healthfirst Essential Plan	$16.43
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$10.85
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.30
Rate for Payer: Wellcare Medicare	$10.85

HB AQUAPORIN-4 (NEUROMYELITIS OPTICA) ANTIBODY; ELISA

Facility

$45.00

Service Code	CPT 86051
Hospital Charge Code	3028605101
Hospital Revenue Code	302
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50

HB AQUAPORIN-4 (NEUROMYELITIS OPTICA) ANTIBODY; ELISA

Facility

$45.00

Service Code	CPT 86051
Hospital Charge Code	3028605101
Hospital Revenue Code	302
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$36.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Affinity Essential Plan 1&2	$8.07
Rate for Payer: Affinity Essential Plan 3&4	$8.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.07
Rate for Payer: Brighton Health Commercial	$33.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.60
Rate for Payer: Elderplan Medicare Advantage	$11.53
Rate for Payer: EmblemHealth Commercial	$11.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.38
Rate for Payer: Fidelis Essential Plan Aliesa	$9.80
Rate for Payer: Fidelis Essential Plan QHP	$10.26
Rate for Payer: Fidelis Medicare Advantage	$11.53
Rate for Payer: Fidelis Qualified Health Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$11.53
Rate for Payer: Group Health Inc Medicare	$11.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.53
Rate for Payer: Hamaspik Choice Inc Medicare	$11.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.98
Rate for Payer: Healthfirst Essential Plan	$15.71
Rate for Payer: Healthfirst Medicare Advantage	$11.53
Rate for Payer: Healthfirst QHP	$11.53
Rate for Payer: Humana Medicare	$11.76
Rate for Payer: Senior Whole Health Medicare Advantage	$11.53
Rate for Payer: United Healthcare Commercial	$10.38
Rate for Payer: United Healthcare Medicare Advantage	$11.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.98
Rate for Payer: Wellcare Medicare	$10.38

HB ASSAY NEURFLMNT LIGHT CHAIN

Facility

$34.00

Service Code	CPT 83884
Hospital Charge Code	3018388401
Hospital Revenue Code	301
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00

HB ASSAY NEURFLMNT LIGHT CHAIN

Facility

$34.00

Service Code	CPT 83884
Hospital Charge Code	3018388401
Hospital Revenue Code	301
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$27.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.00
Rate for Payer: Aetna Government	$17.00
Rate for Payer: Brighton Health Commercial	$25.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.12
Rate for Payer: EmblemHealth Commercial	$17.00
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

HB BETA-AMYLOID 1-40 (ABETA 40)

Facility

$40.00

Service Code	CPT 82233
Hospital Charge Code	3018223301
Hospital Revenue Code	301
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$32.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.00
Rate for Payer: Aetna Government	$20.00
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.20
Rate for Payer: EmblemHealth Commercial	$20.00
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00

HB BETA-AMYLOID 1-40 (ABETA 40)

Facility

$40.00

Service Code	CPT 82233
Hospital Charge Code	3018223301
Hospital Revenue Code	301
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00

HB BETA-AMYLOID 1-42 (ABETA 42)

Facility

$40.00

Service Code	CPT 82234
Hospital Charge Code	3018223401
Hospital Revenue Code	301
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00

HB BETA-AMYLOID 1-42 (ABETA 42)

Facility

$40.00

Service Code	CPT 82234
Hospital Charge Code	3018223401
Hospital Revenue Code	301
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$32.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.00
Rate for Payer: Aetna Government	$20.00
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.20
Rate for Payer: EmblemHealth Commercial	$20.00
Rate for Payer: Group Health Inc Commercial	$20.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00

HB CPTRZ OPH IMG PST SG RTA OCT

Facility

$921.00

Service Code	CPT 92137
Hospital Charge Code	5109213701
Hospital Revenue Code	510
Min. Negotiated Rate	$65.98
Max. Negotiated Rate	$506.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$506.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
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	$380.47
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
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	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$65.98
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$399.49
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

HB CPTRZ OPH IMG PST SG RTA OCT

Facility

$921.00

Service Code	CPT 92137
Hospital Charge Code	5109213701
Hospital Revenue Code	510
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$460.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$460.50

HB CYTOG GENOM-WID ALYS HEM MAL

Facility

$229.00

Service Code	CPT 81195
Hospital Charge Code	3108119501
Hospital Revenue Code	310
Min. Negotiated Rate	$125.95
Max. Negotiated Rate	$1,288.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$125.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,263.53
Rate for Payer: Aetna Government	$1,263.53
Rate for Payer: Affinity Essential Plan 1&2	$884.47
Rate for Payer: Affinity Essential Plan 3&4	$884.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$884.47
Rate for Payer: Brighton Health Commercial	$1,263.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,263.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$183.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$155.72
Rate for Payer: Elderplan Medicare Advantage	$1,263.53
Rate for Payer: EmblemHealth Commercial	$1,263.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,137.18
Rate for Payer: Fidelis Essential Plan Aliesa	$1,074.00
Rate for Payer: Fidelis Essential Plan QHP	$1,124.54
Rate for Payer: Fidelis Medicare Advantage	$1,263.53
Rate for Payer: Fidelis Qualified Health Plan	$1,124.54
Rate for Payer: Group Health Inc Commercial	$1,263.53
Rate for Payer: Group Health Inc Medicare	$1,263.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,263.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1,263.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,263.53
Rate for Payer: Healthfirst Medicare Advantage	$1,263.53
Rate for Payer: Healthfirst QHP	$1,263.53
Rate for Payer: Humana Medicare	$1,288.80
Rate for Payer: Senior Whole Health Medicare Advantage	$1,263.53
Rate for Payer: United Healthcare Medicare Advantage	$1,263.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,263.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,200.35
Rate for Payer: Wellcare Medicare	$1,137.18

Know your out-of-pocket cost for care.

All Charges