St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CL TX CARPAL SCAPHOID FRAC, W/O MANI

Facility

$653.00

Service Code	CPT 25622
Hospital Charge Code	3612562201
Hospital Revenue Code	361
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC CL TX CARPAL SCAPHOID FRAC, W/O MANI

Facility

$653.00

Service Code	CPT 25622
Hospital Charge Code	3612562201
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$350.51
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX DISTAL FIBULAR FRACTURE W/MANIP

Facility

$653.00

Service Code	CPT 27788
Hospital Charge Code	3612778801
Hospital Revenue Code	361
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC CL TX DISTAL FIBULAR FRACTURE W/MANIP

Facility

$653.00

Service Code	CPT 27788
Hospital Charge Code	3612778801
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$467.55
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX DISTAL FIBULAR FRACTURE W/O MANIP

Facility

$653.00

Service Code	CPT 27786
Hospital Charge Code	3612778601
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$349.51
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX DISTAL FIBULAR FRACTURE W/O MANIP

Facility

$653.00

Service Code	CPT 27786
Hospital Charge Code	3612778601
Hospital Revenue Code	361
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC CL TX FEMORAL SHAFT FRAC, W/O MANIP

Facility

$653.00

Service Code	CPT 27500
Hospital Charge Code	3612750001
Hospital Revenue Code	761
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC CL TX FEMORAL SHAFT FRAC, W/O MANIP

Facility

$653.00

Service Code	CPT 27500
Hospital Charge Code	3612750001
Hospital Revenue Code	761
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
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	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$577.72
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX HUMERAL FX MEDIAL LAT W/O MANIP

Facility

$653.00

Service Code	CPT 24576
Hospital Charge Code	3612457601
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$386.50
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX HUMERAL FX MEDIAL LAT W/O MANIP

Facility

$653.00

Service Code	CPT 24576
Hospital Charge Code	3612457601
Hospital Revenue Code	361
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC CL TX NURSEMAID ELBOW W/ MANIP

Facility

$653.00

Service Code	CPT 24640
Hospital Charge Code	3612464001
Hospital Revenue Code	361
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC CL TX NURSEMAID ELBOW W/ MANIP

Facility

$653.00

Service Code	CPT 24640
Hospital Charge Code	3612464001
Hospital Revenue Code	361
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$58.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.15
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX OF CLAVICULAR FRAC W/O MANIP

Facility

$638.00

Service Code	CPT 23500
Hospital Charge Code	3612350001
Hospital Revenue Code	361
Min. Negotiated Rate	$319.00
Max. Negotiated Rate	$319.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$319.00

HC CL TX OF CLAVICULAR FRAC W/O MANIP

Facility

$638.00

Service Code	CPT 23500
Hospital Charge Code	3612350001
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$478.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$284.51
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX TIBIA/FIBIA FRAC W/MANIP, W/ OR W/O ANES

Facility

$3,338.00

Service Code	CPT 27825
Hospital Charge Code	3612782501
Hospital Revenue Code	361
Min. Negotiated Rate	$596.65
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,955.41
Rate for Payer: Aetna Government	$1,955.41
Rate for Payer: Affinity Essential Plan 1&2	$1,368.79
Rate for Payer: Affinity Essential Plan 3&4	$1,368.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,368.79
Rate for Payer: Brighton Health Commercial	$2,503.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,955.41
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	$1,955.41
Rate for Payer: EmblemHealth Commercial	$1,955.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,759.87
Rate for Payer: Fidelis Essential Plan Aliesa	$1,662.10
Rate for Payer: Fidelis Essential Plan QHP	$1,740.31
Rate for Payer: Fidelis Medicare Advantage	$1,955.41
Rate for Payer: Fidelis Qualified Health Plan	$1,740.31
Rate for Payer: Group Health Inc Commercial	$1,955.41
Rate for Payer: Group Health Inc Medicare	$1,955.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,955.41
Rate for Payer: Hamaspik Choice Inc Medicare	$838.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$596.65
Rate for Payer: Healthfirst Medicare Advantage	$1,662.10
Rate for Payer: Healthfirst QHP	$1,955.41
Rate for Payer: Humana Medicare	$1,994.52
Rate for Payer: Senior Whole Health Medicare Advantage	$1,955.41
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,955.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,955.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,857.64
Rate for Payer: Wellcare Medicare	$1,857.64

HC CL TX TIBIA/FIBIA FRAC W/MANIP, W/ OR W/O ANES

Facility

$3,338.00

Service Code	CPT 27825
Hospital Charge Code	3612782501
Hospital Revenue Code	361
Min. Negotiated Rate	$1,669.00
Max. Negotiated Rate	$1,669.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,669.00

HC CL TX TIBIA/FIBIA FRAC W/O MANIP, W/ OR W/O ANES

Facility

$653.00

Service Code	CPT 27824
Hospital Charge Code	3612782401
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$374.22
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC CL TX TIBIA/FIBIA FRAC W/O MANIP, W/ OR W/O ANES

Facility

$653.00

Service Code	CPT 27824
Hospital Charge Code	3612782401
Hospital Revenue Code	361
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC CMPTR OPHTH DX IMG ANT SEGMT - OCT, ANTERIOR SEGMENT - OD - RT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213204
Hospital Revenue Code	920
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00

HC CMPTR OPHTH DX IMG ANT SEGMT - OCT, ANTERIOR SEGMENT - OD - RT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213204
Hospital Revenue Code	920
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$139.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.15
Rate for Payer: Aetna Government	$14.15
Rate for Payer: Brighton Health Commercial	$130.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.32
Rate for Payer: EmblemHealth Commercial	$87.00
Rate for Payer: Group Health Inc Commercial	$87.00
Rate for Payer: Group Health Inc Medicare	$60.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.92
Rate for Payer: United Healthcare Commercial	$94.00

HC CMPTR OPHTH DX IMG ANT SEGMT - OCT, ANTERIOR SEGMENT - OS - LT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213206
Hospital Revenue Code	920
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$139.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.15
Rate for Payer: Aetna Government	$14.15
Rate for Payer: Brighton Health Commercial	$130.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.32
Rate for Payer: EmblemHealth Commercial	$87.00
Rate for Payer: Group Health Inc Commercial	$87.00
Rate for Payer: Group Health Inc Medicare	$60.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.92
Rate for Payer: United Healthcare Commercial	$94.00

HC CMPTR OPHTH DX IMG ANT SEGMT - OCT, ANTERIOR SEGMENT - OS - LT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213206
Hospital Revenue Code	920
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00

HC CMPTR OPHTH DX IMG ANT SEGMT - OCT, ANTERIOR SEGMENT OU BOTH EYES

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213202
Hospital Revenue Code	920
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00

HC CMPTR OPHTH DX IMG ANT SEGMT - OCT, ANTERIOR SEGMENT OU BOTH EYES

Facility

$166.00

Service Code	CPT 92132 TC
Hospital Charge Code	5109213201
Hospital Revenue Code	510
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.15
Rate for Payer: Aetna Government	$14.15
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
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	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.92
Rate for Payer: United Healthcare Commercial	$222.00

HC CMPTR OPHTH DX IMG ANT SEGMT - OCT, ANTERIOR SEGMENT OU BOTH EYES

Facility

$166.00

Service Code	CPT 92132 TC
Hospital Charge Code	5109213201
Hospital Revenue Code	510
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$83.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00

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