St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC BODY FLUID CELL COUNT W DIFF - SYNOVIAL FLUID CELL COUNT

Facility

$11.00

Service Code	CPT 89051
Hospital Charge Code	3008905101
Hospital Revenue Code	300
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50

HC BONE BIOPSY, OPEN, DEEP

Facility

$7,747.00

Service Code	CPT 20245
Hospital Charge Code	3612024501
Hospital Revenue Code	361
Min. Negotiated Rate	$3,873.50
Max. Negotiated Rate	$3,873.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,873.50

HC BONE BIOPSY, OPEN, DEEP

Facility

$7,747.00

Service Code	CPT 20245
Hospital Charge Code	3612024501
Hospital Revenue Code	361
Min. Negotiated Rate	$395.82
Max. Negotiated Rate	$5,810.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,496.91
Rate for Payer: Aetna Government	$3,496.91
Rate for Payer: Affinity Essential Plan 1&2	$2,447.84
Rate for Payer: Affinity Essential Plan 3&4	$2,447.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,447.84
Rate for Payer: Brighton Health Commercial	$5,810.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,496.91
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	$3,496.91
Rate for Payer: EmblemHealth Commercial	$3,496.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,147.22
Rate for Payer: Fidelis Essential Plan Aliesa	$2,972.37
Rate for Payer: Fidelis Essential Plan QHP	$3,112.25
Rate for Payer: Fidelis Medicare Advantage	$3,496.91
Rate for Payer: Fidelis Qualified Health Plan	$3,112.25
Rate for Payer: Group Health Inc Commercial	$3,496.91
Rate for Payer: Group Health Inc Medicare	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicare	$1,201.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$395.82
Rate for Payer: Healthfirst Medicare Advantage	$2,972.37
Rate for Payer: Healthfirst QHP	$3,496.91
Rate for Payer: Humana Medicare	$3,566.85
Rate for Payer: Senior Whole Health Medicare Advantage	$3,496.91
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,496.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,496.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,322.06
Rate for Payer: Wellcare Medicare	$3,322.06

HC BONE BIOPSY, OPEN, SUPERFICIAL

Facility

$7,747.00

Service Code	CPT 20240
Hospital Charge Code	3612024001
Hospital Revenue Code	361
Min. Negotiated Rate	$3,873.50
Max. Negotiated Rate	$3,873.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,873.50

HC BONE BIOPSY, OPEN, SUPERFICIAL

Facility

$7,747.00

Service Code	CPT 20240
Hospital Charge Code	3612024001
Hospital Revenue Code	361
Min. Negotiated Rate	$158.30
Max. Negotiated Rate	$5,810.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,496.91
Rate for Payer: Aetna Government	$3,496.91
Rate for Payer: Affinity Essential Plan 1&2	$2,447.84
Rate for Payer: Affinity Essential Plan 3&4	$2,447.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,447.84
Rate for Payer: Brighton Health Commercial	$5,810.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,496.91
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	$3,496.91
Rate for Payer: EmblemHealth Commercial	$3,496.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,147.22
Rate for Payer: Fidelis Essential Plan Aliesa	$2,972.37
Rate for Payer: Fidelis Essential Plan QHP	$3,112.25
Rate for Payer: Fidelis Medicare Advantage	$3,496.91
Rate for Payer: Fidelis Qualified Health Plan	$3,112.25
Rate for Payer: Group Health Inc Commercial	$3,496.91
Rate for Payer: Group Health Inc Medicare	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicare	$1,201.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$158.30
Rate for Payer: Healthfirst Medicare Advantage	$2,972.37
Rate for Payer: Healthfirst QHP	$3,496.91
Rate for Payer: Humana Medicare	$3,566.85
Rate for Payer: Senior Whole Health Medicare Advantage	$3,496.91
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,496.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,496.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,322.06
Rate for Payer: Wellcare Medicare	$3,322.06

HC BONE BIOPSY,TROCAR/NEEDLE DEEP

Facility

$4,157.00

Service Code	CPT 20225 TC
Hospital Charge Code	3612022501
Hospital Revenue Code	361
Min. Negotiated Rate	$532.71
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$532.71
Rate for Payer: Aetna Government	$532.71
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 BONE BIOPSY,TROCAR/NEEDLE DEEP

Facility

$4,157.00

Service Code	CPT 20225 TC
Hospital Charge Code	3612022501
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 BONE BIOPSY,TROCAR/NEEDLE SUPERF

Facility

$4,157.00

Service Code	CPT 20220 TC
Hospital Charge Code	3612022001
Hospital Revenue Code	361
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.50
Rate for Payer: Aetna Government	$169.50
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	$1,188.00

HC BONE BIOPSY,TROCAR/NEEDLE SUPERF

Facility

$4,157.00

Service Code	CPT 20220 TC
Hospital Charge Code	3612022001
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 BONE IMAGING, 3 PHASE - NM BONE WHOLE BODY 3 PHASE

Facility

$1,079.00

Service Code	CPT 78315 TC
Hospital Charge Code	3417831501
Hospital Revenue Code	341
Min. Negotiated Rate	$195.76
Max. Negotiated Rate	$809.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$593.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.75
Rate for Payer: Aetna Government	$203.75
Rate for Payer: Brighton Health Commercial	$809.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$523.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.79
Rate for Payer: EmblemHealth Commercial	$276.67
Rate for Payer: Group Health Inc Commercial	$539.50
Rate for Payer: Group Health Inc Medicare	$377.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50
Rate for Payer: Hamaspik Choice Inc Medicare	$539.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$276.67
Rate for Payer: Healthfirst Essential Plan	$530.14
Rate for Payer: United Healthcare Commercial	$195.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$235.62

HC BONE IMAGING, 3 PHASE - NM BONE WHOLE BODY 3 PHASE

Facility

$1,079.00

Service Code	CPT 78315 TC
Hospital Charge Code	3417831501
Hospital Revenue Code	341
Min. Negotiated Rate	$539.50
Max. Negotiated Rate	$539.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50

HC BONE IMAGING, LIMITED AREA - NM BONE LIMITED

Facility

$1,079.00

Service Code	CPT 78300 TC
Hospital Charge Code	3417830001
Hospital Revenue Code	341
Min. Negotiated Rate	$102.93
Max. Negotiated Rate	$809.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$593.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$102.93
Rate for Payer: Aetna Government	$102.93
Rate for Payer: Brighton Health Commercial	$809.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$523.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.79
Rate for Payer: EmblemHealth Commercial	$182.63
Rate for Payer: Group Health Inc Commercial	$539.50
Rate for Payer: Group Health Inc Medicare	$377.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50
Rate for Payer: Hamaspik Choice Inc Medicare	$539.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$182.63
Rate for Payer: Healthfirst Essential Plan	$256.12
Rate for Payer: United Healthcare Commercial	$195.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$113.83

HC BONE IMAGING, LIMITED AREA - NM BONE LIMITED

Facility

$1,079.00

Service Code	CPT 78300 TC
Hospital Charge Code	3417830001
Hospital Revenue Code	341
Min. Negotiated Rate	$539.50
Max. Negotiated Rate	$539.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50

HC BONE IMAGING, MULTIPLE AREAS - NM BONE MULTIPLE AREAS

Facility

$1,079.00

Service Code	CPT 78305 TC
Hospital Charge Code	3417830501
Hospital Revenue Code	341
Min. Negotiated Rate	$539.50
Max. Negotiated Rate	$539.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50

HC BONE IMAGING, MULTIPLE AREAS - NM BONE MULTIPLE AREAS

Facility

$1,079.00

Service Code	CPT 78305 TC
Hospital Charge Code	3417830501
Hospital Revenue Code	341
Min. Negotiated Rate	$130.57
Max. Negotiated Rate	$809.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$593.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.57
Rate for Payer: Aetna Government	$130.57
Rate for Payer: Brighton Health Commercial	$809.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$523.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.79
Rate for Payer: EmblemHealth Commercial	$219.17
Rate for Payer: Group Health Inc Commercial	$539.50
Rate for Payer: Group Health Inc Medicare	$377.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50
Rate for Payer: Hamaspik Choice Inc Medicare	$539.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$219.17
Rate for Payer: Healthfirst Essential Plan	$392.04
Rate for Payer: United Healthcare Commercial	$195.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$174.24

HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY

Facility

$1,079.00

Service Code	CPT 78306 TC
Hospital Charge Code	3417830601
Hospital Revenue Code	341
Min. Negotiated Rate	$539.50
Max. Negotiated Rate	$539.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50

HC BONE IMAGING, WHOLE BODY - NM BONE WHOLE BODY

Facility

$1,079.00

Service Code	CPT 78306 TC
Hospital Charge Code	3417830601
Hospital Revenue Code	341
Min. Negotiated Rate	$144.15
Max. Negotiated Rate	$809.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$593.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.15
Rate for Payer: Aetna Government	$144.15
Rate for Payer: Brighton Health Commercial	$809.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$523.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.79
Rate for Payer: EmblemHealth Commercial	$235.94
Rate for Payer: Group Health Inc Commercial	$539.50
Rate for Payer: Group Health Inc Medicare	$377.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$539.50
Rate for Payer: Hamaspik Choice Inc Medicare	$539.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$235.94
Rate for Payer: Healthfirst Essential Plan	$368.32
Rate for Payer: United Healthcare Commercial	$195.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.70

HC BONE MARROW BIOPSY

Facility

$4,157.00

Service Code	CPT 38221
Hospital Charge Code	3613822101
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 BONE MARROW BIOPSY

Facility

$4,157.00

Service Code	CPT 38221
Hospital Charge Code	3613822101
Hospital Revenue Code	361
Min. Negotiated Rate	$77.06
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
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	$3,117.75
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	$111.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$77.06
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 Commercial	$1,188.00
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 BONE MARROW BIOPSY & ASPIRATION

Facility

$7,023.00

Service Code	CPT 38222
Hospital Charge Code	3613822201
Hospital Revenue Code	361
Min. Negotiated Rate	$3,511.50
Max. Negotiated Rate	$3,511.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,511.50

HC BONE MARROW BIOPSY & ASPIRATION

Facility

$7,023.00

Service Code	CPT 38222
Hospital Charge Code	3613822201
Hospital Revenue Code	361
Min. Negotiated Rate	$82.87
Max. Negotiated Rate	$5,267.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,496.91
Rate for Payer: Aetna Government	$3,496.91
Rate for Payer: Affinity Essential Plan 1&2	$2,447.84
Rate for Payer: Affinity Essential Plan 3&4	$2,447.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,447.84
Rate for Payer: Brighton Health Commercial	$5,267.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,496.91
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	$3,496.91
Rate for Payer: EmblemHealth Commercial	$3,496.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,147.22
Rate for Payer: Fidelis Essential Plan Aliesa	$2,972.37
Rate for Payer: Fidelis Essential Plan QHP	$3,112.25
Rate for Payer: Fidelis Medicare Advantage	$3,496.91
Rate for Payer: Fidelis Qualified Health Plan	$3,112.25
Rate for Payer: Group Health Inc Commercial	$3,496.91
Rate for Payer: Group Health Inc Medicare	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicare	$1,201.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$82.87
Rate for Payer: Healthfirst Medicare Advantage	$2,972.37
Rate for Payer: Healthfirst QHP	$3,496.91
Rate for Payer: Humana Medicare	$3,566.85
Rate for Payer: Senior Whole Health Medicare Advantage	$3,496.91
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$3,496.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,496.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,322.06
Rate for Payer: Wellcare Medicare	$3,322.06

HC BONE MARROW BX, NEEDLE/TROCAR

Facility

$4,157.00

Service Code	CPT 38221
Hospital Charge Code	3613822102
Hospital Revenue Code	361
Min. Negotiated Rate	$77.06
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
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	$3,117.75
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	$111.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$77.06
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 Commercial	$1,188.00
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 BONE MARROW BX, NEEDLE/TROCAR

Facility

$4,157.00

Service Code	CPT 38221
Hospital Charge Code	3613822102
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 BONE MARROW IMAGING, LTD - NM BONE MARROW LIMITED

Facility

$1,114.00

Service Code	CPT 78102 TC
Hospital Charge Code	3407810201
Hospital Revenue Code	340
Min. Negotiated Rate	$98.25
Max. Negotiated Rate	$835.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.25
Rate for Payer: Aetna Government	$98.25
Rate for Payer: Brighton Health Commercial	$835.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$550.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$462.97
Rate for Payer: EmblemHealth Commercial	$141.62
Rate for Payer: Group Health Inc Commercial	$557.00
Rate for Payer: Group Health Inc Medicare	$389.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00
Rate for Payer: Hamaspik Choice Inc Medicare	$557.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$141.62
Rate for Payer: Healthfirst Essential Plan	$241.88
Rate for Payer: United Healthcare Commercial	$205.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$107.50

HC BONE MARROW IMAGING, LTD - NM BONE MARROW LIMITED

Facility

$1,114.00

Service Code	CPT 78102 TC
Hospital Charge Code	3407810201
Hospital Revenue Code	340
Min. Negotiated Rate	$557.00
Max. Negotiated Rate	$557.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00

Know your out-of-pocket cost for care.

All Charges