St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - BOOSTER

Facility

$102.00

Service Code	CPT 0054A
Hospital Charge Code	7710054A01
Hospital Revenue Code	771
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.00
Rate for Payer: Aetna Government	$40.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION-BOOSTER

Facility

$102.00

Service Code	CPT 0074A
Hospital Charge Code	7710074A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION-BOOSTER

Facility

$102.00

Service Code	CPT 0074A
Hospital Charge Code	7710074A01
Hospital Revenue Code	771
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.00
Rate for Payer: Aetna Government	$51.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - FIRST DOSE

Facility

$102.00

Service Code	CPT 0051A
Hospital Charge Code	7710051A01
Hospital Revenue Code	771
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.00
Rate for Payer: Aetna Government	$40.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - FIRST DOSE

Facility

$102.00

Service Code	CPT 0051A
Hospital Charge Code	7710051A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - SECOND DOSE

Facility

$102.00

Service Code	CPT 0052A
Hospital Charge Code	7710052A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - SECOND DOSE

Facility

$102.00

Service Code	CPT 0052A
Hospital Charge Code	7710052A01
Hospital Revenue Code	771
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.00
Rate for Payer: Aetna Government	$40.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - THIRD DOSE

Facility

$102.00

Service Code	CPT 0053A
Hospital Charge Code	7710053A01
Hospital Revenue Code	771
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00

HC BIONTECH-PFIZER COVID-19 VACCINE ADMINISTRATION - THIRD DOSE

Facility

$102.00

Service Code	CPT 0053A
Hospital Charge Code	7710053A01
Hospital Revenue Code	771
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.00
Rate for Payer: Aetna Government	$40.00
Rate for Payer: Brighton Health Commercial	$76.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.36
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	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: United Healthcare Commercial	$44.00

HC BIOPSY/EXCISION, LYMPH NODE(S)

Facility

$9,079.00

Service Code	CPT 38500
Hospital Charge Code	3613850001
Hospital Revenue Code	361
Min. Negotiated Rate	$4,539.50
Max. Negotiated Rate	$4,539.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,539.50

HC BIOPSY/EXCISION, LYMPH NODE(S)

Facility

$9,079.00

Service Code	CPT 38500
Hospital Charge Code	3613850001
Hospital Revenue Code	361
Min. Negotiated Rate	$303.73
Max. Negotiated Rate	$6,809.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,678.69
Rate for Payer: Aetna Government	$4,678.69
Rate for Payer: Affinity Essential Plan 1&2	$3,275.08
Rate for Payer: Affinity Essential Plan 3&4	$3,275.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,275.08
Rate for Payer: Brighton Health Commercial	$6,809.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,678.69
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	$4,678.69
Rate for Payer: EmblemHealth Commercial	$4,678.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,210.82
Rate for Payer: Fidelis Essential Plan Aliesa	$3,976.89
Rate for Payer: Fidelis Essential Plan QHP	$4,164.03
Rate for Payer: Fidelis Medicare Advantage	$4,678.69
Rate for Payer: Fidelis Qualified Health Plan	$4,164.03
Rate for Payer: Group Health Inc Commercial	$4,678.69
Rate for Payer: Group Health Inc Medicare	$4,678.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,678.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,538.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$303.73
Rate for Payer: Healthfirst Medicare Advantage	$3,976.89
Rate for Payer: Healthfirst QHP	$4,678.69
Rate for Payer: Humana Medicare	$4,772.26
Rate for Payer: Senior Whole Health Medicare Advantage	$4,678.69
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$4,678.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,678.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,444.76
Rate for Payer: Wellcare Medicare	$4,444.76

HC BIOPSY/EXCISION, LYMPH NODES, INT MAMMARY

Facility

$9,175.00

Service Code	CPT 38530 TC
Hospital Charge Code	3613853001
Hospital Revenue Code	361
Min. Negotiated Rate	$574.06
Max. Negotiated Rate	$6,881.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$574.06
Rate for Payer: Aetna Government	$574.06
Rate for Payer: Brighton Health Commercial	$6,881.25
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	$4,587.50
Rate for Payer: Group Health Inc Commercial	$4,587.50
Rate for Payer: Group Health Inc Medicare	$3,211.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,587.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,538.05
Rate for Payer: United Healthcare Commercial	$1,468.00

HC BIOPSY/EXCISION, LYMPH NODES, INT MAMMARY

Facility

$9,175.00

Service Code	CPT 38530 TC
Hospital Charge Code	3613853001
Hospital Revenue Code	361
Min. Negotiated Rate	$4,587.50
Max. Negotiated Rate	$4,587.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,587.50

HC BIOPSY, FLOOR OF MOUTH

Facility

$4,157.00

Service Code	CPT 41108
Hospital Charge Code	5104110801
Hospital Revenue Code	510
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC BIOPSY, FLOOR OF MOUTH

Facility

$4,157.00

Service Code	CPT 41108
Hospital Charge Code	5104110801
Hospital Revenue Code	510
Min. Negotiated Rate	$107.17
Max. Negotiated Rate	$2,078.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
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	$233.00
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	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$1,979.64
Rate for Payer: EmblemHealth Commercial	$250.00
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	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,979.64
Rate for Payer: Hamaspik Choice Inc Medicare	$122.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$107.17
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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2,078.62
Rate for Payer: Senior Whole Health Medicare Advantage	$1,979.64
Rate for Payer: United Healthcare Commercial	$222.00
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

HC BIOPSY OF BREAST, INCISIONAL

Facility

$12,032.00

Service Code	CPT 19101
Hospital Charge Code	3611910101
Hospital Revenue Code	361
Min. Negotiated Rate	$267.85
Max. Negotiated Rate	$9,024.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,678.69
Rate for Payer: Aetna Government	$4,678.69
Rate for Payer: Affinity Essential Plan 1&2	$3,275.08
Rate for Payer: Affinity Essential Plan 3&4	$3,275.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,275.08
Rate for Payer: Brighton Health Commercial	$9,024.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,678.69
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	$4,678.69
Rate for Payer: EmblemHealth Commercial	$4,678.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,210.82
Rate for Payer: Fidelis Essential Plan Aliesa	$3,976.89
Rate for Payer: Fidelis Essential Plan QHP	$4,164.03
Rate for Payer: Fidelis Medicare Advantage	$4,678.69
Rate for Payer: Fidelis Qualified Health Plan	$4,164.03
Rate for Payer: Group Health Inc Commercial	$4,678.69
Rate for Payer: Group Health Inc Medicare	$4,678.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,678.69
Rate for Payer: Hamaspik Choice Inc Medicare	$1,538.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$267.85
Rate for Payer: Healthfirst Medicare Advantage	$3,976.89
Rate for Payer: Healthfirst QHP	$4,678.69
Rate for Payer: Humana Medicare	$4,772.26
Rate for Payer: Senior Whole Health Medicare Advantage	$4,678.69
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$4,678.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,678.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,444.76
Rate for Payer: Wellcare Medicare	$4,444.76

HC BIOPSY OF BREAST, INCISIONAL

Facility

$12,032.00

Service Code	CPT 19101
Hospital Charge Code	3611910101
Hospital Revenue Code	361
Min. Negotiated Rate	$6,016.00
Max. Negotiated Rate	$6,016.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,016.00

HC BIOPSY OF BREAST, NEEDLE CORE

Facility

$4,157.00

Service Code	CPT 19100 TC
Hospital Charge Code	3611910002
Hospital Revenue Code	361
Min. Negotiated Rate	$62.33
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.33
Rate for Payer: Aetna Government	$62.33
Rate for Payer: Brighton Health Commercial	$3,117.75
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	$2,078.50
Rate for Payer: Group Health Inc Commercial	$2,078.50
Rate for Payer: Group Health Inc Medicare	$1,454.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicare	$708.28
Rate for Payer: United Healthcare Commercial	$1,409.00

HC BIOPSY OF BREAST, NEEDLE CORE

Facility

$4,157.00

Service Code	CPT 19100 TC
Hospital Charge Code	3611910001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC BIOPSY OF BREAST, NEEDLE CORE

Facility

$4,157.00

Service Code	CPT 19100 TC
Hospital Charge Code	3611910002
Hospital Revenue Code	361
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC BIOPSY OF BREAST, NEEDLE CORE

Facility

$4,157.00

Service Code	CPT 19100 TC
Hospital Charge Code	3611910001
Hospital Revenue Code	361
Min. Negotiated Rate	$62.33
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.33
Rate for Payer: Aetna Government	$62.33
Rate for Payer: Brighton Health Commercial	$3,117.75
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	$2,078.50
Rate for Payer: Group Health Inc Commercial	$2,078.50
Rate for Payer: Group Health Inc Medicare	$1,454.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicare	$708.28
Rate for Payer: United Healthcare Commercial	$1,409.00

HC BIOPSY OF CERVIX, SINGLE OR MULTIPLE

Facility

$1,933.00

Service Code	CPT 57500
Hospital Charge Code	5105750001
Hospital Revenue Code	510
Min. Negotiated Rate	$87.47
Max. Negotiated Rate	$1,117.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,063.89
Rate for Payer: Aetna Government	$1,063.89
Rate for Payer: Affinity Essential Plan 1&2	$744.72
Rate for Payer: Affinity Essential Plan 3&4	$744.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$744.72
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,063.89
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	$1,063.89
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$957.50
Rate for Payer: Fidelis Essential Plan Aliesa	$904.31
Rate for Payer: Fidelis Essential Plan QHP	$946.86
Rate for Payer: Fidelis Medicare Advantage	$1,063.89
Rate for Payer: Fidelis Qualified Health Plan	$946.86
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	$1,063.89
Rate for Payer: Hamaspik Choice Inc Medicare	$100.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$87.47
Rate for Payer: Healthfirst Medicare Advantage	$904.31
Rate for Payer: Healthfirst QHP	$1,063.89
Rate for Payer: Humana Medicare	$1,085.17
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,117.08
Rate for Payer: Senior Whole Health Medicare Advantage	$1,063.89
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,063.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,063.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,010.70
Rate for Payer: Wellcare Medicare	$1,010.70

HC BIOPSY OF CERVIX, SINGLE OR MULTIPLE

Facility

$1,933.00

Service Code	CPT 57500
Hospital Charge Code	5105750001
Hospital Revenue Code	510
Min. Negotiated Rate	$966.50
Max. Negotiated Rate	$966.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$966.50

HC BIOPSY OF EXTERNAL EAR

Facility

$616.00

Service Code	CPT 69100
Hospital Charge Code	5106910001
Hospital Revenue Code	510
Min. Negotiated Rate	$51.87
Max. Negotiated Rate	$780.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.73
Rate for Payer: Aetna Government	$283.73
Rate for Payer: Affinity Essential Plan 1&2	$198.61
Rate for Payer: Affinity Essential Plan 3&4	$198.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.61
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.73
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	$283.73
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$255.36
Rate for Payer: Fidelis Essential Plan Aliesa	$241.17
Rate for Payer: Fidelis Essential Plan QHP	$252.52
Rate for Payer: Fidelis Medicare Advantage	$283.73
Rate for Payer: Fidelis Qualified Health Plan	$252.52
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	$283.73
Rate for Payer: Hamaspik Choice Inc Medicare	$62.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51.87
Rate for Payer: Healthfirst Medicare Advantage	$241.17
Rate for Payer: Healthfirst QHP	$283.73
Rate for Payer: Humana Medicare	$289.40
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$297.92
Rate for Payer: Senior Whole Health Medicare Advantage	$283.73
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$283.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$269.54
Rate for Payer: Wellcare Medicare	$269.54

HC BIOPSY OF EXTERNAL EAR

Facility

$616.00

Service Code	CPT 69100
Hospital Charge Code	5106910001
Hospital Revenue Code	510
Min. Negotiated Rate	$308.00
Max. Negotiated Rate	$308.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$308.00

Know your out-of-pocket cost for care.

All Charges