St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ASSAY UREA NITROGEN, QUAN - POST-DIALYSIS BUN (BLOOD UREA NITROGEN)

Facility

$9.00

Service Code	CPT 84520
Hospital Charge Code	3018452002
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50

HC ASSAY UREA NITROGEN, QUAN - UREA NITROGEN, BODY FLUID

Facility

$9.00

Service Code	CPT 84520
Hospital Charge Code	3018452005
Hospital Revenue Code	301
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$8.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.95
Rate for Payer: Aetna Government	$3.95
Rate for Payer: Affinity Essential Plan 1&2	$2.77
Rate for Payer: Affinity Essential Plan 3&4	$2.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.77
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.64
Rate for Payer: Elderplan Medicare Advantage	$3.95
Rate for Payer: EmblemHealth Commercial	$3.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.56
Rate for Payer: Fidelis Essential Plan Aliesa	$3.36
Rate for Payer: Fidelis Essential Plan QHP	$3.52
Rate for Payer: Fidelis Medicare Advantage	$3.95
Rate for Payer: Fidelis Qualified Health Plan	$3.52
Rate for Payer: Group Health Inc Commercial	$3.95
Rate for Payer: Group Health Inc Medicare	$3.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.95
Rate for Payer: Hamaspik Choice Inc Medicare	$3.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.95
Rate for Payer: Healthfirst Essential Plan	$8.89
Rate for Payer: Healthfirst Medicare Advantage	$3.95
Rate for Payer: Healthfirst QHP	$3.95
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Senior Whole Health Medicare Advantage	$3.95
Rate for Payer: United Healthcare Commercial	$5.00
Rate for Payer: United Healthcare Medicare Advantage	$3.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.95
Rate for Payer: Wellcare Medicare	$3.56

HC ASSAY UREA NITROGEN, QUAN - UREA NITROGEN, BODY FLUID

Facility

$9.00

Service Code	CPT 84520
Hospital Charge Code	3018452005
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50

HC ASSAY URINE UREA-N - UREA NITROGEN TIMED URINE

Facility

$13.00

Service Code	CPT 84540
Hospital Charge Code	3018454001
Hospital Revenue Code	301
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50

HC ASSAY URINE UREA-N - UREA NITROGEN TIMED URINE

Facility

$13.00

Service Code	CPT 84540
Hospital Charge Code	3018454001
Hospital Revenue Code	301
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$11.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.56
Rate for Payer: Aetna Government	$5.56
Rate for Payer: Affinity Essential Plan 1&2	$3.89
Rate for Payer: Affinity Essential Plan 3&4	$3.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.89
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.79
Rate for Payer: Elderplan Medicare Advantage	$5.56
Rate for Payer: EmblemHealth Commercial	$5.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.00
Rate for Payer: Fidelis Essential Plan Aliesa	$4.73
Rate for Payer: Fidelis Essential Plan QHP	$4.95
Rate for Payer: Fidelis Medicare Advantage	$5.56
Rate for Payer: Fidelis Qualified Health Plan	$4.95
Rate for Payer: Group Health Inc Commercial	$5.56
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.56
Rate for Payer: Hamaspik Choice Inc Medicare	$5.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.08
Rate for Payer: Healthfirst Essential Plan	$11.43
Rate for Payer: Healthfirst Medicare Advantage	$5.56
Rate for Payer: Healthfirst QHP	$5.56
Rate for Payer: Humana Medicare	$5.67
Rate for Payer: Senior Whole Health Medicare Advantage	$5.56
Rate for Payer: United Healthcare Commercial	$6.01
Rate for Payer: United Healthcare Medicare Advantage	$5.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.08
Rate for Payer: Wellcare Medicare	$5.00

HC ASSAY URINE UREA-N - UREA NITROGEN, URINE

Facility

$13.00

Service Code	CPT 84540
Hospital Charge Code	3018454002
Hospital Revenue Code	301
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50

HC ASSAY URINE UREA-N - UREA NITROGEN, URINE

Facility

$13.00

Service Code	CPT 84540
Hospital Charge Code	3018454002
Hospital Revenue Code	301
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$11.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.56
Rate for Payer: Aetna Government	$5.56
Rate for Payer: Affinity Essential Plan 1&2	$3.89
Rate for Payer: Affinity Essential Plan 3&4	$3.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.89
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.79
Rate for Payer: Elderplan Medicare Advantage	$5.56
Rate for Payer: EmblemHealth Commercial	$5.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.00
Rate for Payer: Fidelis Essential Plan Aliesa	$4.73
Rate for Payer: Fidelis Essential Plan QHP	$4.95
Rate for Payer: Fidelis Medicare Advantage	$5.56
Rate for Payer: Fidelis Qualified Health Plan	$4.95
Rate for Payer: Group Health Inc Commercial	$5.56
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.56
Rate for Payer: Hamaspik Choice Inc Medicare	$5.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.08
Rate for Payer: Healthfirst Essential Plan	$11.43
Rate for Payer: Healthfirst Medicare Advantage	$5.56
Rate for Payer: Healthfirst QHP	$5.56
Rate for Payer: Humana Medicare	$5.67
Rate for Payer: Senior Whole Health Medicare Advantage	$5.56
Rate for Payer: United Healthcare Commercial	$6.01
Rate for Payer: United Healthcare Medicare Advantage	$5.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.08
Rate for Payer: Wellcare Medicare	$5.00

HC ASSISTED METHADONE TRMNT

Facility

$258.00

Service Code	CPT G2067
Hospital Charge Code	900G206701
Hospital Revenue Code	900
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00

HC ASSISTED METHADONE TRMNT

Facility

$258.00

Service Code	CPT G2067
Hospital Charge Code	900G206701
Hospital Revenue Code	900
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$620.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$233.15
Rate for Payer: Aetna Government	$233.15
Rate for Payer: Affinity Essential Plan 1&2	$620.23
Rate for Payer: Affinity Essential Plan 3&4	$620.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$275.66
Rate for Payer: Amida Care Medicaid	$275.66
Rate for Payer: Brighton Health Commercial	$193.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.44
Rate for Payer: EmblemHealth Commercial	$129.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$620.23
Rate for Payer: EmblemHealth Essential Plan 3&4	$275.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$275.66
Rate for Payer: Fidelis Essential Plan Aliesa	$620.23
Rate for Payer: Fidelis Essential Plan QHP	$620.23
Rate for Payer: Fidelis Qualified Health Plan	$289.44
Rate for Payer: Group Health Inc Commercial	$129.00
Rate for Payer: Group Health Inc Medicare	$90.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.66
Rate for Payer: Hamaspik Choice Inc Medicare	$275.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$275.66
Rate for Payer: Healthfirst Essential Plan	$620.23
Rate for Payer: Healthfirst QHP	$449.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$275.66
Rate for Payer: SOMOS Essential	$620.23
Rate for Payer: United Healthcare Commercial	$129.00
Rate for Payer: United Healthcare Essential Plan 1&2	$620.23
Rate for Payer: United Healthcare Essential Plan 3&4	$303.22
Rate for Payer: United Healthcare Medicaid	$275.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$275.66

HC ASSTD MED NOT OTHERWISE SPECIFIED

Facility

$397.00

Service Code	CPT G2075
Hospital Charge Code	900G207501
Hospital Revenue Code	900
Min. Negotiated Rate	$138.95
Max. Negotiated Rate	$317.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$218.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$198.50
Rate for Payer: Aetna Government	$198.50
Rate for Payer: Brighton Health Commercial	$297.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$317.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$269.96
Rate for Payer: EmblemHealth Commercial	$198.50
Rate for Payer: Group Health Inc Commercial	$198.50
Rate for Payer: Group Health Inc Medicare	$138.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.50
Rate for Payer: Hamaspik Choice Inc Medicare	$198.50
Rate for Payer: United Healthcare Commercial	$198.50

HC ASSTD MED NOT OTHERWISE SPECIFIED

Facility

$397.00

Service Code	CPT G2075
Hospital Charge Code	900G207501
Hospital Revenue Code	900
Min. Negotiated Rate	$198.50
Max. Negotiated Rate	$198.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.50

HC ASSTD MED TRMT DRUG NOT INCLUDED

Facility

$358.00

Service Code	CPT G2074
Hospital Charge Code	900G207401
Hospital Revenue Code	900
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$286.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$196.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$185.80
Rate for Payer: Aetna Government	$185.80
Rate for Payer: Brighton Health Commercial	$268.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$286.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.44
Rate for Payer: EmblemHealth Commercial	$179.00
Rate for Payer: Group Health Inc Commercial	$179.00
Rate for Payer: Group Health Inc Medicare	$125.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00
Rate for Payer: Hamaspik Choice Inc Medicare	$179.00
Rate for Payer: United Healthcare Commercial	$179.00

HC ASSTD MED TRMT DRUG NOT INCLUDED

Facility

$358.00

Service Code	CPT G2074
Hospital Charge Code	900G207401
Hospital Revenue Code	900
Min. Negotiated Rate	$179.00
Max. Negotiated Rate	$179.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.00

HC ASSTD NALTREXONE TRMT

Facility

$258.00

Service Code	CPT G2073
Hospital Charge Code	900G207301
Hospital Revenue Code	900
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$1,369.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,369.29
Rate for Payer: Aetna Government	$1,369.29
Rate for Payer: Brighton Health Commercial	$193.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.44
Rate for Payer: EmblemHealth Commercial	$129.00
Rate for Payer: Group Health Inc Commercial	$129.00
Rate for Payer: Group Health Inc Medicare	$90.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00
Rate for Payer: Hamaspik Choice Inc Medicare	$129.00
Rate for Payer: United Healthcare Commercial	$129.00

HC ASSTD NALTREXONE TRMT

Facility

$258.00

Service Code	CPT G2073
Hospital Charge Code	900G207301
Hospital Revenue Code	900
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00

HC ASTHMA EDUCATION, NONPHYSICIAN PROVIDER, PER SESSION

Facility

$10.00

Service Code	CPT S9441
Hospital Charge Code	942S944101
Hospital Revenue Code	942
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC ASTHMA EDUCATION, NONPHYSICIAN PROVIDER, PER SESSION

Facility

$10.00

Service Code	CPT S9441
Hospital Charge Code	942S944101
Hospital Revenue Code	942
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.67
Rate for Payer: Aetna Government	$20.67
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	$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	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: United Healthcare Commercial	$5.00

HC AUDIOMETRY, AIR & BONE

Facility

$419.00

Service Code	CPT 92553
Hospital Charge Code	4719255301
Hospital Revenue Code	471
Min. Negotiated Rate	$56.51
Max. Negotiated Rate	$335.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.17
Rate for Payer: Aetna Government	$191.17
Rate for Payer: Affinity Essential Plan 1&2	$133.82
Rate for Payer: Affinity Essential Plan 3&4	$133.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$133.82
Rate for Payer: Brighton Health Commercial	$314.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$191.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.92
Rate for Payer: Elderplan Medicare Advantage	$191.17
Rate for Payer: EmblemHealth Commercial	$191.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$172.05
Rate for Payer: Fidelis Essential Plan Aliesa	$162.49
Rate for Payer: Fidelis Essential Plan QHP	$170.14
Rate for Payer: Fidelis Medicare Advantage	$191.17
Rate for Payer: Fidelis Qualified Health Plan	$170.14
Rate for Payer: Group Health Inc Commercial	$191.17
Rate for Payer: Group Health Inc Medicare	$191.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.17
Rate for Payer: Hamaspik Choice Inc Medicare	$191.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$56.51
Rate for Payer: Healthfirst Medicare Advantage	$162.49
Rate for Payer: Healthfirst QHP	$191.17
Rate for Payer: Humana Medicare	$194.99
Rate for Payer: Senior Whole Health Medicare Advantage	$191.17
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$191.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.61
Rate for Payer: Wellcare Medicare	$181.61

HC AUDIOMETRY, AIR & BONE

Facility

$419.00

Service Code	CPT 92553
Hospital Charge Code	4719255301
Hospital Revenue Code	471
Min. Negotiated Rate	$209.50
Max. Negotiated Rate	$209.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50

HC AUDITORY FUNCTION, 60 MIN

Facility

$419.00

Service Code	CPT 92620
Hospital Charge Code	4719262001
Hospital Revenue Code	471
Min. Negotiated Rate	$86.36
Max. Negotiated Rate	$335.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.17
Rate for Payer: Aetna Government	$191.17
Rate for Payer: Affinity Essential Plan 1&2	$133.82
Rate for Payer: Affinity Essential Plan 3&4	$133.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$133.82
Rate for Payer: Brighton Health Commercial	$314.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$191.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.92
Rate for Payer: Elderplan Medicare Advantage	$191.17
Rate for Payer: EmblemHealth Commercial	$191.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$172.05
Rate for Payer: Fidelis Essential Plan Aliesa	$162.49
Rate for Payer: Fidelis Essential Plan QHP	$170.14
Rate for Payer: Fidelis Medicare Advantage	$191.17
Rate for Payer: Fidelis Qualified Health Plan	$170.14
Rate for Payer: Group Health Inc Commercial	$191.17
Rate for Payer: Group Health Inc Medicare	$191.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.17
Rate for Payer: Hamaspik Choice Inc Medicare	$191.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$86.36
Rate for Payer: Healthfirst Medicare Advantage	$162.49
Rate for Payer: Healthfirst QHP	$191.17
Rate for Payer: Humana Medicare	$194.99
Rate for Payer: Senior Whole Health Medicare Advantage	$191.17
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$191.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.61
Rate for Payer: Wellcare Medicare	$181.61

HC AUDITORY FUNCTION, 60 MIN

Facility

$419.00

Service Code	CPT 92620
Hospital Charge Code	4719262001
Hospital Revenue Code	471
Min. Negotiated Rate	$209.50
Max. Negotiated Rate	$209.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50

HC AUTOPSY GROSS,W/O CNS - LAB AUTOPSY GROSS,W/O CNS

Facility

$1,500.00

Service Code	CPT 88000 TC
Hospital Charge Code	3108800001
Hospital Revenue Code	310
Min. Negotiated Rate	$148.15
Max. Negotiated Rate	$1,125.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$148.15
Rate for Payer: Aetna Government	$148.15
Rate for Payer: Brighton Health Commercial	$1,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$234.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$197.55
Rate for Payer: EmblemHealth Commercial	$750.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

HC AUTOPSY GROSS,W/O CNS - LAB AUTOPSY GROSS,W/O CNS

Facility

$1,500.00

Service Code	CPT 88000 TC
Hospital Charge Code	3108800001
Hospital Revenue Code	310
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00

HC AVULSION OF NAIL PLATE, EACH ADD'L (ADDON)

Facility

$264.00

Service Code	CPT 11732
Hospital Charge Code	3611173201
Hospital Revenue Code	361
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$132.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.00

HC AVULSION OF NAIL PLATE, EACH ADD'L (ADDON)

Facility

$264.00

Service Code	CPT 11732
Hospital Charge Code	3611173201
Hospital Revenue Code	361
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.19
Rate for Payer: Aetna Government	$16.19
Rate for Payer: Brighton Health Commercial	$198.00
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	$132.00
Rate for Payer: Group Health Inc Commercial	$132.00
Rate for Payer: Group Health Inc Medicare	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.00
Rate for Payer: Hamaspik Choice Inc Medicare	$132.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18.44
Rate for Payer: United Healthcare Commercial	$1,113.00

Know your out-of-pocket cost for care.

All Charges