St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ARTHROGRAM OF ELBOW - XR ELBOW ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73085 TC
Hospital Charge Code	3227308501
Hospital Revenue Code	322
Min. Negotiated Rate	$53.42
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$53.42
Rate for Payer: Aetna Government	$53.42
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$588.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$495.42
Rate for Payer: EmblemHealth Commercial	$76.01
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.01
Rate for Payer: Healthfirst Essential Plan	$142.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63.13

HC ARTHROGRAM OF ELBOW - XR ELBOW ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73085 TC
Hospital Charge Code	3227308501
Hospital Revenue Code	322
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC ARTHROGRAM OF HIP - XR HIP ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73525 TC
Hospital Charge Code	3227352501
Hospital Revenue Code	322
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC ARTHROGRAM OF HIP - XR HIP ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73525 TC
Hospital Charge Code	3227352501
Hospital Revenue Code	322
Min. Negotiated Rate	$56.77
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.77
Rate for Payer: Aetna Government	$56.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$588.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$495.42
Rate for Payer: EmblemHealth Commercial	$101.86
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$101.86
Rate for Payer: Healthfirst Essential Plan	$145.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.86

HC ARTHROGRAM OF KNEE JOINT - XR KNEE ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73580 TC
Hospital Charge Code	3227358001
Hospital Revenue Code	322
Min. Negotiated Rate	$67.92
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.92
Rate for Payer: Aetna Government	$67.92
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$588.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$495.42
Rate for Payer: EmblemHealth Commercial	$81.25
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$81.25
Rate for Payer: Healthfirst Essential Plan	$192.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$85.41

HC ARTHROGRAM OF KNEE JOINT - XR KNEE ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73580 TC
Hospital Charge Code	3227358001
Hospital Revenue Code	322
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73040 TC
Hospital Charge Code	3227304001
Hospital Revenue Code	322
Min. Negotiated Rate	$56.77
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.77
Rate for Payer: Aetna Government	$56.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$588.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$495.42
Rate for Payer: EmblemHealth Commercial	$107.80
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$107.80
Rate for Payer: Healthfirst Essential Plan	$156.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69.73

HC ARTHROGRAM OF SHOULDER - XR SHOULDER ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73040 TC
Hospital Charge Code	3227304001
Hospital Revenue Code	322
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC ARTHROGRAM OF WRIST - XR WRIST ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73115 TC
Hospital Charge Code	3227311501
Hospital Revenue Code	322
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC ARTHROGRAM OF WRIST - XR WRIST ARTHROGRAM

Facility

$1,156.00

Service Code	CPT 73115 TC
Hospital Charge Code	3227311501
Hospital Revenue Code	322
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.23
Rate for Payer: Aetna Government	$61.23
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$588.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$495.42
Rate for Payer: EmblemHealth Commercial	$109.21
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$109.21
Rate for Payer: Healthfirst Essential Plan	$158.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70.62

HC ARTHROTOMY, METACARPOPHALANGEAL JOINT, EACH

Facility

$8,291.00

Service Code	CPT 26075
Hospital Charge Code	3612607501
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 ARTHROTOMY, METACARPOPHALANGEAL JOINT, EACH

Facility

$8,291.00

Service Code	CPT 26075
Hospital Charge Code	3612607501
Hospital Revenue Code	361
Min. Negotiated Rate	$408.83
Max. Negotiated Rate	$6,218.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
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	$408.83
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 ASPA GENE ANALYSIS - CANAVAN DISEASE

Facility

$118.00

Service Code	CPT 81200
Hospital Charge Code	3108120002
Hospital Revenue Code	310
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$59.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.00

HC ASPA GENE ANALYSIS - CANAVAN DISEASE

Facility

$118.00

Service Code	CPT 81200
Hospital Charge Code	3108120002
Hospital Revenue Code	310
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$94.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.25
Rate for Payer: Aetna Government	$47.25
Rate for Payer: Affinity Essential Plan 1&2	$33.08
Rate for Payer: Affinity Essential Plan 3&4	$33.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$33.08
Rate for Payer: Brighton Health Commercial	$47.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.24
Rate for Payer: Elderplan Medicare Advantage	$47.25
Rate for Payer: EmblemHealth Commercial	$47.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.52
Rate for Payer: Fidelis Essential Plan Aliesa	$40.16
Rate for Payer: Fidelis Essential Plan QHP	$42.05
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Fidelis Qualified Health Plan	$42.05
Rate for Payer: Group Health Inc Commercial	$47.25
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.25
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.25
Rate for Payer: Healthfirst Medicare Advantage	$47.25
Rate for Payer: Healthfirst QHP	$47.25
Rate for Payer: Humana Medicare	$48.20
Rate for Payer: Senior Whole Health Medicare Advantage	$47.25
Rate for Payer: United Healthcare Medicare Advantage	$47.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44.89
Rate for Payer: Wellcare Medicare	$42.52

HC ASPA GENE ANALYSIS COMMON VARIANTS - GENE TEST CANAVAN

Facility

$6,121.00

Service Code	CPT 81200
Hospital Charge Code	3008120001
Hospital Revenue Code	300
Min. Negotiated Rate	$3,060.50
Max. Negotiated Rate	$3,060.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,060.50

HC ASPA GENE ANALYSIS COMMON VARIANTS - GENE TEST CANAVAN

Facility

$6,121.00

Service Code	CPT 81200
Hospital Charge Code	3008120001
Hospital Revenue Code	300
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$4,896.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,366.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.25
Rate for Payer: Aetna Government	$47.25
Rate for Payer: Affinity Essential Plan 1&2	$33.08
Rate for Payer: Affinity Essential Plan 3&4	$33.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$33.08
Rate for Payer: Brighton Health Commercial	$4,590.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,896.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,162.28
Rate for Payer: Elderplan Medicare Advantage	$47.25
Rate for Payer: EmblemHealth Commercial	$47.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.52
Rate for Payer: Fidelis Essential Plan Aliesa	$40.16
Rate for Payer: Fidelis Essential Plan QHP	$42.05
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Fidelis Qualified Health Plan	$42.05
Rate for Payer: Group Health Inc Commercial	$47.25
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.25
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.25
Rate for Payer: Healthfirst Medicare Advantage	$47.25
Rate for Payer: Healthfirst QHP	$47.25
Rate for Payer: Humana Medicare	$48.20
Rate for Payer: Senior Whole Health Medicare Advantage	$47.25
Rate for Payer: United Healthcare Commercial	$42.52
Rate for Payer: United Healthcare Medicare Advantage	$47.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44.89
Rate for Payer: Wellcare Medicare	$42.52

HC ASPA GENE ANALYSIS - INHERITEST SOCIETY GUIDED PANEL

Facility

$6,121.00

Service Code	CPT 81200
Hospital Charge Code	3108120001
Hospital Revenue Code	310
Min. Negotiated Rate	$3,060.50
Max. Negotiated Rate	$3,060.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,060.50

HC ASPA GENE ANALYSIS - INHERITEST SOCIETY GUIDED PANEL

Facility

$6,121.00

Service Code	CPT 81200
Hospital Charge Code	3108120001
Hospital Revenue Code	310
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$4,896.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,366.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.25
Rate for Payer: Aetna Government	$47.25
Rate for Payer: Affinity Essential Plan 1&2	$33.08
Rate for Payer: Affinity Essential Plan 3&4	$33.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$33.08
Rate for Payer: Brighton Health Commercial	$47.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,896.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,162.28
Rate for Payer: Elderplan Medicare Advantage	$47.25
Rate for Payer: EmblemHealth Commercial	$47.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.52
Rate for Payer: Fidelis Essential Plan Aliesa	$40.16
Rate for Payer: Fidelis Essential Plan QHP	$42.05
Rate for Payer: Fidelis Medicare Advantage	$47.25
Rate for Payer: Fidelis Qualified Health Plan	$42.05
Rate for Payer: Group Health Inc Commercial	$47.25
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.25
Rate for Payer: Hamaspik Choice Inc Medicare	$47.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.25
Rate for Payer: Healthfirst Medicare Advantage	$47.25
Rate for Payer: Healthfirst QHP	$47.25
Rate for Payer: Humana Medicare	$48.20
Rate for Payer: Senior Whole Health Medicare Advantage	$47.25
Rate for Payer: United Healthcare Medicare Advantage	$47.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44.89
Rate for Payer: Wellcare Medicare	$42.52

HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS

Facility

$37.00

Service Code	CPT 86606
Hospital Charge Code	3028660601
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$27.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.05
Rate for Payer: Aetna Government	$15.05
Rate for Payer: Affinity Essential Plan 1&2	$10.54
Rate for Payer: Affinity Essential Plan 3&4	$10.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.54
Rate for Payer: Brighton Health Commercial	$27.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.53
Rate for Payer: Elderplan Medicare Advantage	$15.05
Rate for Payer: EmblemHealth Commercial	$15.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.54
Rate for Payer: Fidelis Essential Plan Aliesa	$12.79
Rate for Payer: Fidelis Essential Plan QHP	$13.39
Rate for Payer: Fidelis Medicare Advantage	$15.05
Rate for Payer: Fidelis Qualified Health Plan	$13.39
Rate for Payer: Group Health Inc Commercial	$15.05
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.05
Rate for Payer: Hamaspik Choice Inc Medicare	$15.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.11
Rate for Payer: Healthfirst Essential Plan	$18.25
Rate for Payer: Healthfirst Medicare Advantage	$15.05
Rate for Payer: Healthfirst QHP	$15.05
Rate for Payer: Humana Medicare	$15.35
Rate for Payer: Senior Whole Health Medicare Advantage	$15.05
Rate for Payer: United Healthcare Commercial	$19.07
Rate for Payer: United Healthcare Medicare Advantage	$15.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.11
Rate for Payer: Wellcare Medicare	$13.54

HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS

Facility

$37.00

Service Code	CPT 86606
Hospital Charge Code	3028660601
Hospital Revenue Code	302
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50

HC ASPERGILLUS ANTIBODY - QN, DID

Facility

$37.00

Service Code	CPT 86606
Hospital Charge Code	3028660602
Hospital Revenue Code	302
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50

HC ASPERGILLUS ANTIBODY - QN, DID

Facility

$37.00

Service Code	CPT 86606
Hospital Charge Code	3028660602
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$27.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.05
Rate for Payer: Aetna Government	$15.05
Rate for Payer: Affinity Essential Plan 1&2	$10.54
Rate for Payer: Affinity Essential Plan 3&4	$10.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.54
Rate for Payer: Brighton Health Commercial	$27.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.53
Rate for Payer: Elderplan Medicare Advantage	$15.05
Rate for Payer: EmblemHealth Commercial	$15.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.54
Rate for Payer: Fidelis Essential Plan Aliesa	$12.79
Rate for Payer: Fidelis Essential Plan QHP	$13.39
Rate for Payer: Fidelis Medicare Advantage	$15.05
Rate for Payer: Fidelis Qualified Health Plan	$13.39
Rate for Payer: Group Health Inc Commercial	$15.05
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.05
Rate for Payer: Hamaspik Choice Inc Medicare	$15.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.11
Rate for Payer: Healthfirst Essential Plan	$18.25
Rate for Payer: Healthfirst Medicare Advantage	$15.05
Rate for Payer: Healthfirst QHP	$15.05
Rate for Payer: Humana Medicare	$15.35
Rate for Payer: Senior Whole Health Medicare Advantage	$15.05
Rate for Payer: United Healthcare Commercial	$19.07
Rate for Payer: United Healthcare Medicare Advantage	$15.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.11
Rate for Payer: Wellcare Medicare	$13.54

HC ASPIRAT/INJECTION GANGLION CYST(S)

Facility

$792.00

Service Code	CPT 20612
Hospital Charge Code	3612061201
Hospital Revenue Code	361
Min. Negotiated Rate	$37.85
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$360.67
Rate for Payer: Aetna Government	$360.67
Rate for Payer: Affinity Essential Plan 1&2	$252.47
Rate for Payer: Affinity Essential Plan 3&4	$252.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$252.47
Rate for Payer: Brighton Health Commercial	$594.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$360.67
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	$360.67
Rate for Payer: EmblemHealth Commercial	$360.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$324.60
Rate for Payer: Fidelis Essential Plan Aliesa	$306.57
Rate for Payer: Fidelis Essential Plan QHP	$321.00
Rate for Payer: Fidelis Medicare Advantage	$360.67
Rate for Payer: Fidelis Qualified Health Plan	$321.00
Rate for Payer: Group Health Inc Commercial	$360.67
Rate for Payer: Group Health Inc Medicare	$360.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$360.67
Rate for Payer: Hamaspik Choice Inc Medicare	$37.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.37
Rate for Payer: Healthfirst Medicare Advantage	$306.57
Rate for Payer: Healthfirst QHP	$360.67
Rate for Payer: Humana Medicare	$367.88
Rate for Payer: Senior Whole Health Medicare Advantage	$360.67
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$360.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$360.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$342.64
Rate for Payer: Wellcare Medicare	$342.64

HC ASPIRAT/INJECTION GANGLION CYST(S)

Facility

$792.00

Service Code	CPT 20612
Hospital Charge Code	3612061201
Hospital Revenue Code	361
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$396.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.00

HC ASSAY ALKAL PHOSPHATASE - ALKALINE PHOSPHATASE

Facility

$12.00

Service Code	CPT 84075
Hospital Charge Code	3018407501
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

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