St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC AMINO ACIDS, 6+ QUANT - AMINO ACIDS, PLASMA

Facility

$49.00

Service Code	CPT 82139
Hospital Charge Code	3018213902
Hospital Revenue Code	301
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$36.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.87
Rate for Payer: Aetna Government	$16.87
Rate for Payer: Affinity Essential Plan 1&2	$11.81
Rate for Payer: Affinity Essential Plan 3&4	$11.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.81
Rate for Payer: Brighton Health Commercial	$36.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.14
Rate for Payer: Elderplan Medicare Advantage	$16.87
Rate for Payer: EmblemHealth Commercial	$16.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15.18
Rate for Payer: Fidelis Essential Plan Aliesa	$14.34
Rate for Payer: Fidelis Essential Plan QHP	$15.01
Rate for Payer: Fidelis Medicare Advantage	$16.87
Rate for Payer: Fidelis Qualified Health Plan	$15.01
Rate for Payer: Group Health Inc Commercial	$16.87
Rate for Payer: Group Health Inc Medicare	$16.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.87
Rate for Payer: Hamaspik Choice Inc Medicare	$16.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.14
Rate for Payer: Healthfirst Essential Plan	$31.82
Rate for Payer: Healthfirst Medicare Advantage	$16.87
Rate for Payer: Healthfirst QHP	$16.87
Rate for Payer: Humana Medicare	$17.21
Rate for Payer: Senior Whole Health Medicare Advantage	$16.87
Rate for Payer: United Healthcare Commercial	$21.37
Rate for Payer: United Healthcare Medicare Advantage	$16.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.14
Rate for Payer: Wellcare Medicare	$15.18

HC AMINO ACIDS, 6+ QUANT - AMINO ACIDS, PLASMA

Facility

$49.00

Service Code	CPT 82139
Hospital Charge Code	3018213902
Hospital Revenue Code	301
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50

HC AMINO ACIDS, SINGLE QUANTITATION - CYSTINE URINE QUANTITATIVE

Facility

$57.00

Service Code	CPT 82131
Hospital Charge Code	3018213101
Hospital Revenue Code	301
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.50

HC AMINO ACIDS, SINGLE QUANTITATION - CYSTINE URINE QUANTITATIVE

Facility

$57.00

Service Code	CPT 82131
Hospital Charge Code	3018213101
Hospital Revenue Code	301
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$42.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.98
Rate for Payer: Aetna Government	$22.98
Rate for Payer: Affinity Essential Plan 1&2	$16.09
Rate for Payer: Affinity Essential Plan 3&4	$16.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$16.09
Rate for Payer: Brighton Health Commercial	$42.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$22.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.14
Rate for Payer: Elderplan Medicare Advantage	$22.98
Rate for Payer: EmblemHealth Commercial	$22.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20.68
Rate for Payer: Fidelis Essential Plan Aliesa	$19.53
Rate for Payer: Fidelis Essential Plan QHP	$20.45
Rate for Payer: Fidelis Medicare Advantage	$22.98
Rate for Payer: Fidelis Qualified Health Plan	$20.45
Rate for Payer: Group Health Inc Commercial	$22.98
Rate for Payer: Group Health Inc Medicare	$22.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.98
Rate for Payer: Hamaspik Choice Inc Medicare	$22.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.14
Rate for Payer: Healthfirst Essential Plan	$31.82
Rate for Payer: Healthfirst Medicare Advantage	$22.98
Rate for Payer: Healthfirst QHP	$22.98
Rate for Payer: Humana Medicare	$23.44
Rate for Payer: Senior Whole Health Medicare Advantage	$22.98
Rate for Payer: United Healthcare Commercial	$21.37
Rate for Payer: United Healthcare Medicare Advantage	$22.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.14
Rate for Payer: Wellcare Medicare	$20.68

HC AMNT PAIN NOTED NON PRSNT

Facility

$10.00

Service Code	CPT 1126F
Hospital Charge Code	9691126F01
Hospital Revenue Code	969
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC AMNT PAIN NOTED NON PRSNT

Facility

$10.00

Service Code	CPT 1126F
Hospital Charge Code	9691126F01
Hospital Revenue Code	969
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.00
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

HC AMNT PAIN NOTED PAIN PRESNT

Facility

$10.00

Service Code	CPT 1125F
Hospital Charge Code	9691125F01
Hospital Revenue Code	969
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.00
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

HC AMNT PAIN NOTED PAIN PRESNT

Facility

$10.00

Service Code	CPT 1125F
Hospital Charge Code	9691125F01
Hospital Revenue Code	969
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC AMPUTATION FINGER/THUMB, DIRECT CLOSURE

Facility

$8,291.00

Service Code	CPT 26951
Hospital Charge Code	3612695101
Hospital Revenue Code	361
Min. Negotiated Rate	$4,145.50
Max. Negotiated Rate	$4,145.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.50

HC AMPUTATION FINGER/THUMB, DIRECT CLOSURE

Facility

$8,291.00

Service Code	CPT 26951
Hospital Charge Code	3612695101
Hospital Revenue Code	361
Min. Negotiated Rate	$830.57
Max. Negotiated Rate	$6,218.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,964.33
Rate for Payer: Aetna Government	$3,964.33
Rate for Payer: Affinity Essential Plan 1&2	$2,775.03
Rate for Payer: Affinity Essential Plan 3&4	$2,775.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,775.03
Rate for Payer: Brighton Health Commercial	$6,218.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,964.33
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	$3,964.33
Rate for Payer: EmblemHealth Commercial	$3,964.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,567.90
Rate for Payer: Fidelis Essential Plan Aliesa	$3,369.68
Rate for Payer: Fidelis Essential Plan QHP	$3,528.25
Rate for Payer: Fidelis Medicare Advantage	$3,964.33
Rate for Payer: Fidelis Qualified Health Plan	$3,528.25
Rate for Payer: Group Health Inc Commercial	$3,964.33
Rate for Payer: Group Health Inc Medicare	$3,964.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,964.33
Rate for Payer: Hamaspik Choice Inc Medicare	$1,579.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$830.57
Rate for Payer: Healthfirst Medicare Advantage	$3,369.68
Rate for Payer: Healthfirst QHP	$3,964.33
Rate for Payer: Humana Medicare	$4,043.62
Rate for Payer: Senior Whole Health Medicare Advantage	$3,964.33
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$3,964.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,964.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,766.11
Rate for Payer: Wellcare Medicare	$3,766.11

HC AMPUTATION TOE, METAATARSOPHALANGEAL JOINT

Facility

$8,291.00

Service Code	CPT 28820
Hospital Charge Code	3612882001
Hospital Revenue Code	361
Min. Negotiated Rate	$4,145.50
Max. Negotiated Rate	$4,145.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.50

HC AMPUTATION TOE, METAATARSOPHALANGEAL JOINT

Facility

$8,291.00

Service Code	CPT 28820
Hospital Charge Code	3612882001
Hospital Revenue Code	361
Min. Negotiated Rate	$200.76
Max. Negotiated Rate	$6,218.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,964.33
Rate for Payer: Aetna Government	$3,964.33
Rate for Payer: Affinity Essential Plan 1&2	$2,775.03
Rate for Payer: Affinity Essential Plan 3&4	$2,775.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,775.03
Rate for Payer: Brighton Health Commercial	$6,218.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,964.33
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	$3,964.33
Rate for Payer: EmblemHealth Commercial	$3,964.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,567.90
Rate for Payer: Fidelis Essential Plan Aliesa	$3,369.68
Rate for Payer: Fidelis Essential Plan QHP	$3,528.25
Rate for Payer: Fidelis Medicare Advantage	$3,964.33
Rate for Payer: Fidelis Qualified Health Plan	$3,528.25
Rate for Payer: Group Health Inc Commercial	$3,964.33
Rate for Payer: Group Health Inc Medicare	$3,964.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,964.33
Rate for Payer: Hamaspik Choice Inc Medicare	$1,579.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$200.76
Rate for Payer: Healthfirst Medicare Advantage	$3,369.68
Rate for Payer: Healthfirst QHP	$3,964.33
Rate for Payer: Humana Medicare	$4,043.62
Rate for Payer: Senior Whole Health Medicare Advantage	$3,964.33
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,964.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,964.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,766.11
Rate for Payer: Wellcare Medicare	$3,766.11

HC ANALGESIA

Facility

$78.00

Service Code	CPT D9230
Hospital Charge Code	361D923001
Hospital Revenue Code	361
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$244.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.47
Rate for Payer: Aetna Government	$17.47
Rate for Payer: Affinity Essential Plan 1&2	$244.11
Rate for Payer: Affinity Essential Plan 3&4	$244.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$108.49
Rate for Payer: Amida Care Medicaid	$108.49
Rate for Payer: Brighton Health Commercial	$58.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.04
Rate for Payer: EmblemHealth Commercial	$39.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$244.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$108.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108.49
Rate for Payer: Fidelis Essential Plan Aliesa	$244.11
Rate for Payer: Fidelis Essential Plan QHP	$244.11
Rate for Payer: Fidelis Qualified Health Plan	$113.92
Rate for Payer: Group Health Inc Commercial	$39.00
Rate for Payer: Group Health Inc Medicare	$27.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.49
Rate for Payer: Hamaspik Choice Inc Medicare	$108.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$108.49
Rate for Payer: Healthfirst Essential Plan	$244.11
Rate for Payer: Healthfirst QHP	$176.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.49
Rate for Payer: SOMOS Essential	$244.11
Rate for Payer: United Healthcare Essential Plan 1&2	$244.11
Rate for Payer: United Healthcare Essential Plan 3&4	$119.34
Rate for Payer: United Healthcare Medicaid	$108.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$108.49

HC ANALGESIA

Facility

$78.00

Service Code	CPT D9230
Hospital Charge Code	361D923001
Hospital Revenue Code	361
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00

HC ANALYZE NEUROSTIM,SIMPLE/PROG

Facility

$343.00

Service Code	CPT 95971
Hospital Charge Code	9209597101
Hospital Revenue Code	920
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$274.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.15
Rate for Payer: Aetna Government	$112.15
Rate for Payer: Affinity Essential Plan 1&2	$78.50
Rate for Payer: Affinity Essential Plan 3&4	$78.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$78.50
Rate for Payer: Brighton Health Commercial	$257.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$112.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$274.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$233.24
Rate for Payer: Elderplan Medicare Advantage	$112.15
Rate for Payer: EmblemHealth Commercial	$112.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$100.94
Rate for Payer: Fidelis Essential Plan Aliesa	$95.33
Rate for Payer: Fidelis Essential Plan QHP	$99.81
Rate for Payer: Fidelis Medicare Advantage	$112.15
Rate for Payer: Fidelis Qualified Health Plan	$99.81
Rate for Payer: Group Health Inc Commercial	$112.15
Rate for Payer: Group Health Inc Medicare	$112.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.15
Rate for Payer: Hamaspik Choice Inc Medicare	$112.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.61
Rate for Payer: Healthfirst Medicare Advantage	$95.33
Rate for Payer: Healthfirst QHP	$112.15
Rate for Payer: Humana Medicare	$114.39
Rate for Payer: Senior Whole Health Medicare Advantage	$112.15
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$112.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$112.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$106.54
Rate for Payer: Wellcare Medicare	$106.54

HC ANALYZE NEUROSTIM,SIMPLE/PROG

Facility

$343.00

Service Code	CPT 95971
Hospital Charge Code	9209597101
Hospital Revenue Code	920
Min. Negotiated Rate	$171.50
Max. Negotiated Rate	$171.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.50

HC ANESTHESIA TIME ADD'L 15 MINS

Facility

$121.00

Hospital Charge Code	3700000002
Hospital Revenue Code	370
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$96.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.50
Rate for Payer: Aetna Government	$60.50
Rate for Payer: Brighton Health Commercial	$90.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.28
Rate for Payer: EmblemHealth Commercial	$60.50
Rate for Payer: Group Health Inc Commercial	$60.50
Rate for Payer: Group Health Inc Medicare	$42.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.50
Rate for Payer: Hamaspik Choice Inc Medicare	$60.50

HC ANESTHESIA TIME ADD'L 15 MINS

Facility

$121.00

Hospital Charge Code	3700000002
Hospital Revenue Code	370
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$60.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.50

HC ANESTHESIA TIME FIRST HOUR

Facility

$1,215.00

Hospital Charge Code	3700000001
Hospital Revenue Code	370
Min. Negotiated Rate	$425.25
Max. Negotiated Rate	$972.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$668.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$607.50
Rate for Payer: Aetna Government	$607.50
Rate for Payer: Brighton Health Commercial	$911.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$972.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$826.20
Rate for Payer: EmblemHealth Commercial	$607.50
Rate for Payer: Group Health Inc Commercial	$607.50
Rate for Payer: Group Health Inc Medicare	$425.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$607.50
Rate for Payer: Hamaspik Choice Inc Medicare	$607.50

HC ANESTHESIA TIME FIRST HOUR

Facility

$1,215.00

Hospital Charge Code	3700000001
Hospital Revenue Code	370
Min. Negotiated Rate	$607.50
Max. Negotiated Rate	$607.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$607.50

HC ANGIO ADRENAL BILAT SELECT - IR ANGIOGRAM ADRENAL SELECTIVE BILAT

Facility

$8,393.00

Service Code	CPT 75733 TC
Hospital Charge Code	3237573302
Hospital Revenue Code	323
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC ANGIO ADRENAL BILAT SELECT - IR ANGIOGRAM ADRENAL SELECTIVE BILAT

Facility

$8,393.00

Service Code	CPT 75733 TC
Hospital Charge Code	3237573302
Hospital Revenue Code	323
Min. Negotiated Rate	$94.99
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$94.99
Rate for Payer: Aetna Government	$94.99
Rate for Payer: Brighton Health Commercial	$6,294.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$118.91
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$118.91
Rate for Payer: Healthfirst Essential Plan	$768.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$341.51

HC ANGIO ADRENAL UNILAT SELECT - IR ANGIOGRAM ADRENAL SELECTIVE

Facility

$4,940.00

Service Code	CPT 75731 TC
Hospital Charge Code	3237573101
Hospital Revenue Code	323
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC ANGIO ADRENAL UNILAT SELECT - IR ANGIOGRAM ADRENAL SELECTIVE

Facility

$4,940.00

Service Code	CPT 75731 TC
Hospital Charge Code	3237573101
Hospital Revenue Code	323
Min. Negotiated Rate	$90.66
Max. Negotiated Rate	$4,336.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.66
Rate for Payer: Aetna Government	$90.66
Rate for Payer: Brighton Health Commercial	$3,705.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
Rate for Payer: EmblemHealth Commercial	$106.12
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$106.12
Rate for Payer: Healthfirst Essential Plan	$708.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$314.75

HC ANGIO EA ADDNL SELECTV VESSEL - IR ANGIO SELECTIVE EA ADDL VESSEL

Facility

$2,729.00

Service Code	CPT 75774 TC
Hospital Charge Code	3237577401
Hospital Revenue Code	323
Min. Negotiated Rate	$1,364.50
Max. Negotiated Rate	$1,364.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,364.50

Know your out-of-pocket cost for care.

All Charges