St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CATH THROMBOLYSIS,CORONARY,IV INFUSN

Facility

$1,396.00

Service Code	CPT 92977
Hospital Charge Code	4819297701
Hospital Revenue Code	481
Min. Negotiated Rate	$698.00
Max. Negotiated Rate	$698.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$698.00

HC CATH TIME - EACH INCREMENTAL 1 MINUTE

Facility

$18.00

Hospital Charge Code	4810000002
Hospital Revenue Code	481
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00

HC CATH TIME - EACH INCREMENTAL 1 MINUTE

Facility

$18.00

Hospital Charge Code	4810000002
Hospital Revenue Code	481
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.00
Rate for Payer: Aetna Government	$9.00
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: EmblemHealth Commercial	$9.00
Rate for Payer: Group Health Inc Commercial	$9.00
Rate for Payer: Group Health Inc Medicare	$6.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9.00

HC CATH TIME - INITIAL BASE CHARGE

Facility

$562.00

Hospital Charge Code	4810000001
Hospital Revenue Code	481
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$281.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00

HC CATH TIME - INITIAL BASE CHARGE

Facility

$562.00

Hospital Charge Code	4810000001
Hospital Revenue Code	481
Min. Negotiated Rate	$196.70
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$281.00
Rate for Payer: Aetna Government	$281.00
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00

HC CATH TRANSCATH PLACMT,RAD DELIV DEV,CORONARY

Facility

$874.00

Service Code	CPT 92974
Hospital Charge Code	4819297401
Hospital Revenue Code	481
Min. Negotiated Rate	$150.94
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$480.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$150.94
Rate for Payer: Aetna Government	$150.94
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: EmblemHealth Commercial	$437.00
Rate for Payer: Group Health Inc Commercial	$437.00
Rate for Payer: Group Health Inc Medicare	$305.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00
Rate for Payer: Hamaspik Choice Inc Medicare	$437.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$184.90
Rate for Payer: United Healthcare Commercial	$1,113.00

HC CATH TRANSCATH PLACMT,RAD DELIV DEV,CORONARY

Facility

$874.00

Service Code	CPT 92974
Hospital Charge Code	4819297401
Hospital Revenue Code	481
Min. Negotiated Rate	$437.00
Max. Negotiated Rate	$437.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.00

HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST

Facility

$551.00

Service Code	CPT 71270 TC
Hospital Charge Code	3527127001
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CAT SCAN OF CHEST COMBO - CT CHEST W WO CONTRAST

Facility

$551.00

Service Code	CPT 71270 TC
Hospital Charge Code	3527127001
Hospital Revenue Code	352
Min. Negotiated Rate	$147.48
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$214.95
Rate for Payer: Aetna Government	$214.95
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$147.48
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$147.48
Rate for Payer: Healthfirst Essential Plan	$556.85
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$247.49

HC CAT SCAN OF CHEST CONTRAST - CT CHEST PULMONARY EMBOLISM W IV CONT

Facility

$551.00

Service Code	CPT 71260 TC
Hospital Charge Code	3527126001
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CAT SCAN OF CHEST CONTRAST - CT CHEST PULMONARY EMBOLISM W IV CONT

Facility

$551.00

Service Code	CPT 71260 TC
Hospital Charge Code	3527126001
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.00
Rate for Payer: Aetna Government	$174.00
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$120.59
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$120.59
Rate for Payer: Healthfirst Essential Plan	$453.26
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$201.45

HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST

Facility

$551.00

Service Code	CPT 71260 TC
Hospital Charge Code	3527126002
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CAT SCAN OF CHEST CONTRAST - CT CHEST W CONTRAST

Facility

$551.00

Service Code	CPT 71260 TC
Hospital Charge Code	3527126002
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$174.00
Rate for Payer: Aetna Government	$174.00
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$120.59
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$120.59
Rate for Payer: Healthfirst Essential Plan	$453.26
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$201.45

HC CC LUNG OR AIRWAY BIOPSY 1 LOBE

Facility

$9,390.00

Service Code	CPT 31628 TC
Hospital Charge Code	3613162801
Hospital Revenue Code	361
Min. Negotiated Rate	$4,695.00
Max. Negotiated Rate	$4,695.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,695.00

HC CC LUNG OR AIRWAY BIOPSY 1 LOBE

Facility

$9,390.00

Service Code	CPT 31628 TC
Hospital Charge Code	3613162801
Hospital Revenue Code	361
Min. Negotiated Rate	$433.82
Max. Negotiated Rate	$7,042.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$433.82
Rate for Payer: Aetna Government	$433.82
Rate for Payer: Brighton Health Commercial	$7,042.50
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	$4,695.00
Rate for Payer: Group Health Inc Commercial	$4,695.00
Rate for Payer: Group Health Inc Medicare	$3,286.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,695.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,610.31
Rate for Payer: United Healthcare Commercial	$1,409.00

HC CC R HRT CATH CHD ABNL NT CNJ

Facility

$8,926.00

Service Code	CPT 93594
Hospital Charge Code	4819359401
Hospital Revenue Code	481
Min. Negotiated Rate	$4,463.00
Max. Negotiated Rate	$4,463.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,463.00

HC CC R HRT CATH CHD ABNL NT CNJ

Facility

$8,926.00

Service Code	CPT 93594
Hospital Charge Code	4819359401
Hospital Revenue Code	481
Min. Negotiated Rate	$2,750.91
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,909.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,929.87
Rate for Payer: Aetna Government	$3,929.87
Rate for Payer: Affinity Essential Plan 1&2	$2,750.91
Rate for Payer: Affinity Essential Plan 3&4	$2,750.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,750.91
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,929.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: Elderplan Medicare Advantage	$3,929.87
Rate for Payer: EmblemHealth Commercial	$3,929.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,536.88
Rate for Payer: Fidelis Essential Plan Aliesa	$3,340.39
Rate for Payer: Fidelis Essential Plan QHP	$3,497.58
Rate for Payer: Fidelis Medicare Advantage	$3,929.87
Rate for Payer: Fidelis Qualified Health Plan	$3,497.58
Rate for Payer: Group Health Inc Commercial	$3,929.87
Rate for Payer: Group Health Inc Medicare	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3,929.87
Rate for Payer: Healthfirst Medicare Advantage	$3,340.39
Rate for Payer: Healthfirst QHP	$3,929.87
Rate for Payer: Humana Medicare	$4,008.47
Rate for Payer: Senior Whole Health Medicare Advantage	$3,929.87
Rate for Payer: United Healthcare Medicare Advantage	$3,929.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,929.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,733.38
Rate for Payer: Wellcare Medicare	$3,733.38

HC CC R HRT CATH CHD NML NT CNJ

Facility

$8,926.00

Service Code	CPT 93593
Hospital Charge Code	4819359301
Hospital Revenue Code	481
Min. Negotiated Rate	$4,463.00
Max. Negotiated Rate	$4,463.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,463.00

HC CC R HRT CATH CHD NML NT CNJ

Facility

$8,926.00

Service Code	CPT 93593
Hospital Charge Code	4819359301
Hospital Revenue Code	481
Min. Negotiated Rate	$2,750.91
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,909.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,929.87
Rate for Payer: Aetna Government	$3,929.87
Rate for Payer: Affinity Essential Plan 1&2	$2,750.91
Rate for Payer: Affinity Essential Plan 3&4	$2,750.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,750.91
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,929.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: Elderplan Medicare Advantage	$3,929.87
Rate for Payer: EmblemHealth Commercial	$3,929.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,536.88
Rate for Payer: Fidelis Essential Plan Aliesa	$3,340.39
Rate for Payer: Fidelis Essential Plan QHP	$3,497.58
Rate for Payer: Fidelis Medicare Advantage	$3,929.87
Rate for Payer: Fidelis Qualified Health Plan	$3,497.58
Rate for Payer: Group Health Inc Commercial	$3,929.87
Rate for Payer: Group Health Inc Medicare	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3,929.87
Rate for Payer: Healthfirst Medicare Advantage	$3,340.39
Rate for Payer: Healthfirst QHP	$3,929.87
Rate for Payer: Humana Medicare	$4,008.47
Rate for Payer: Senior Whole Health Medicare Advantage	$3,929.87
Rate for Payer: United Healthcare Medicare Advantage	$3,929.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,929.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,733.38
Rate for Payer: Wellcare Medicare	$3,733.38

HC CC R&L HRT CATH CHD ABNL NT CNJ

Facility

$8,926.00

Service Code	CPT 93597
Hospital Charge Code	4819359701
Hospital Revenue Code	481
Min. Negotiated Rate	$4,463.00
Max. Negotiated Rate	$4,463.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,463.00

HC CC R&L HRT CATH CHD ABNL NT CNJ

Facility

$8,926.00

Service Code	CPT 93597
Hospital Charge Code	4819359701
Hospital Revenue Code	481
Min. Negotiated Rate	$2,750.91
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,909.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,929.87
Rate for Payer: Aetna Government	$3,929.87
Rate for Payer: Affinity Essential Plan 1&2	$2,750.91
Rate for Payer: Affinity Essential Plan 3&4	$2,750.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,750.91
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,929.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: Elderplan Medicare Advantage	$3,929.87
Rate for Payer: EmblemHealth Commercial	$3,929.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,536.88
Rate for Payer: Fidelis Essential Plan Aliesa	$3,340.39
Rate for Payer: Fidelis Essential Plan QHP	$3,497.58
Rate for Payer: Fidelis Medicare Advantage	$3,929.87
Rate for Payer: Fidelis Qualified Health Plan	$3,497.58
Rate for Payer: Group Health Inc Commercial	$3,929.87
Rate for Payer: Group Health Inc Medicare	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3,929.87
Rate for Payer: Healthfirst Medicare Advantage	$3,340.39
Rate for Payer: Healthfirst QHP	$3,929.87
Rate for Payer: Humana Medicare	$4,008.47
Rate for Payer: Senior Whole Health Medicare Advantage	$3,929.87
Rate for Payer: United Healthcare Medicare Advantage	$3,929.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,929.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,733.38
Rate for Payer: Wellcare Medicare	$3,733.38

HC CC R&L HRT CATH CHD NML NT CNJ

Facility

$8,926.00

Service Code	CPT 93596
Hospital Charge Code	4819359601
Hospital Revenue Code	481
Min. Negotiated Rate	$4,463.00
Max. Negotiated Rate	$4,463.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,463.00

HC CC R&L HRT CATH CHD NML NT CNJ

Facility

$8,926.00

Service Code	CPT 93596
Hospital Charge Code	4819359601
Hospital Revenue Code	481
Min. Negotiated Rate	$2,750.91
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,909.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,929.87
Rate for Payer: Aetna Government	$3,929.87
Rate for Payer: Affinity Essential Plan 1&2	$2,750.91
Rate for Payer: Affinity Essential Plan 3&4	$2,750.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,750.91
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,929.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,261.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,472.52
Rate for Payer: Elderplan Medicare Advantage	$3,929.87
Rate for Payer: EmblemHealth Commercial	$3,929.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,536.88
Rate for Payer: Fidelis Essential Plan Aliesa	$3,340.39
Rate for Payer: Fidelis Essential Plan QHP	$3,497.58
Rate for Payer: Fidelis Medicare Advantage	$3,929.87
Rate for Payer: Fidelis Qualified Health Plan	$3,497.58
Rate for Payer: Group Health Inc Commercial	$3,929.87
Rate for Payer: Group Health Inc Medicare	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,929.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3,929.87
Rate for Payer: Healthfirst Medicare Advantage	$3,340.39
Rate for Payer: Healthfirst QHP	$3,929.87
Rate for Payer: Humana Medicare	$4,008.47
Rate for Payer: Senior Whole Health Medicare Advantage	$3,929.87
Rate for Payer: United Healthcare Medicare Advantage	$3,929.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,929.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,733.38
Rate for Payer: Wellcare Medicare	$3,733.38

HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT

Facility

$11.00

Service Code	CPT 89050
Hospital Charge Code	3008905001
Hospital Revenue Code	300
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$8.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.72
Rate for Payer: Aetna Government	$4.72
Rate for Payer: Affinity Essential Plan 1&2	$3.30
Rate for Payer: Affinity Essential Plan 3&4	$3.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.30
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Elderplan Medicare Advantage	$4.72
Rate for Payer: EmblemHealth Commercial	$4.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.25
Rate for Payer: Fidelis Essential Plan Aliesa	$4.01
Rate for Payer: Fidelis Essential Plan QHP	$4.20
Rate for Payer: Fidelis Medicare Advantage	$4.72
Rate for Payer: Fidelis Qualified Health Plan	$4.20
Rate for Payer: Group Health Inc Commercial	$4.72
Rate for Payer: Group Health Inc Medicare	$4.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.72
Rate for Payer: Hamaspik Choice Inc Medicare	$4.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.83
Rate for Payer: Healthfirst Essential Plan	$6.37
Rate for Payer: Healthfirst Medicare Advantage	$4.72
Rate for Payer: Healthfirst QHP	$4.72
Rate for Payer: Humana Medicare	$4.81
Rate for Payer: Senior Whole Health Medicare Advantage	$4.72
Rate for Payer: United Healthcare Commercial	$5.99
Rate for Payer: United Healthcare Medicare Advantage	$4.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.83
Rate for Payer: Wellcare Medicare	$4.25

HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT

Facility

$11.00

Service Code	CPT 89050
Hospital Charge Code	3008905001
Hospital Revenue Code	300
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50

Know your out-of-pocket cost for care.

All Charges