St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

HC CMPTR OPHTH DX IMG ANT SGMT - HEIDELBERG RETINA TOMOGRAPHY OU BOTH

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213203
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 SGMT - HEIDELBERG RETINA TOMOGRAPHY OU BOTH

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213203
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 SGMT - HEIDELBERG RETINA TOMOGRAPHY OU LT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213201
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 SGMT - HEIDELBERG RETINA TOMOGRAPHY OU LT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213201
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 SGMT - HEIDELBERG RETINA TOMOGRAPHY OU RT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213205
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 SGMT - HEIDELBERG RETINA TOMOGRAPHY OU RT EYE

Facility

$174.00

Service Code	CPT 92132 TC
Hospital Charge Code	9209213205
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 IMG OPTIC NERVE - OCT, OPTIC NERVE - OD - UNI/BILAT

Facility

$172.00

Service Code	CPT 92133 TC
Hospital Charge Code	5109213301
Hospital Revenue Code	510
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.46
Rate for Payer: Aetna Government	$14.46
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	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.92
Rate for Payer: United Healthcare Commercial	$222.00

HC CMPTR OPHTH IMG OPTIC NERVE - OCT, OPTIC NERVE - OD - UNI/BILAT

Facility

$172.00

Service Code	CPT 92133 TC
Hospital Charge Code	5109213301
Hospital Revenue Code	510
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00

HC CMPTR OPHTH IMG OPTIC NERVE - OCT, OPTIC NERVE - OS - LEFT EYE

Facility

$172.00

Service Code	CPT 92133 TC
Hospital Charge Code	9209213302
Hospital Revenue Code	920
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00

HC CMPTR OPHTH IMG OPTIC NERVE - OCT, OPTIC NERVE - OS - LEFT EYE

Facility

$172.00

Service Code	CPT 92133 TC
Hospital Charge Code	9209213302
Hospital Revenue Code	920
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$137.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.46
Rate for Payer: Aetna Government	$14.46
Rate for Payer: Brighton Health Commercial	$129.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.96
Rate for Payer: EmblemHealth Commercial	$86.00
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.92
Rate for Payer: United Healthcare Commercial	$94.00

HC CMPTR OPHTH IMG OPTIC NERVE - OCT, OPTIC NERVE - OU - BOTH EYES

Facility

$172.00

Service Code	CPT 92133 TC
Hospital Charge Code	9209213303
Hospital Revenue Code	920
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00

HC CMPTR OPHTH IMG OPTIC NERVE - OCT, OPTIC NERVE - OU - BOTH EYES

Facility

$172.00

Service Code	CPT 92133 TC
Hospital Charge Code	9209213303
Hospital Revenue Code	920
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$137.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.46
Rate for Payer: Aetna Government	$14.46
Rate for Payer: Brighton Health Commercial	$129.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.96
Rate for Payer: EmblemHealth Commercial	$86.00
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.92
Rate for Payer: United Healthcare Commercial	$94.00

HC CMV ANTIBODY - CMV IGG

Facility

$35.00

Service Code	CPT 86644
Hospital Charge Code	3028664401
Hospital Revenue Code	302
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50

HC CMV ANTIBODY - CMV IGG

Facility

$35.00

Service Code	CPT 86644
Hospital Charge Code	3028664401
Hospital Revenue Code	302
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$32.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.39
Rate for Payer: Aetna Government	$14.39
Rate for Payer: Affinity Essential Plan 1&2	$10.07
Rate for Payer: Affinity Essential Plan 3&4	$10.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.07
Rate for Payer: Brighton Health Commercial	$26.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.58
Rate for Payer: Elderplan Medicare Advantage	$14.39
Rate for Payer: EmblemHealth Commercial	$14.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.95
Rate for Payer: Fidelis Essential Plan Aliesa	$12.23
Rate for Payer: Fidelis Essential Plan QHP	$12.81
Rate for Payer: Fidelis Medicare Advantage	$14.39
Rate for Payer: Fidelis Qualified Health Plan	$12.81
Rate for Payer: Group Health Inc Commercial	$14.39
Rate for Payer: Group Health Inc Medicare	$14.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.39
Rate for Payer: Hamaspik Choice Inc Medicare	$14.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.39
Rate for Payer: Healthfirst Essential Plan	$32.38
Rate for Payer: Healthfirst Medicare Advantage	$14.39
Rate for Payer: Healthfirst QHP	$14.39
Rate for Payer: Humana Medicare	$14.68
Rate for Payer: Senior Whole Health Medicare Advantage	$14.39
Rate for Payer: United Healthcare Commercial	$18.23
Rate for Payer: United Healthcare Medicare Advantage	$14.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.39
Rate for Payer: Wellcare Medicare	$12.95

HC CMV ANTIBODY, IGM - CMV IGM

Facility

$42.00

Service Code	CPT 86645
Hospital Charge Code	3028664501
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00

HC CMV ANTIBODY, IGM - CMV IGM

Facility

$42.00

Service Code	CPT 86645
Hospital Charge Code	3028664501
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.85
Rate for Payer: Aetna Government	$16.85
Rate for Payer: Affinity Essential Plan 1&2	$11.79
Rate for Payer: Affinity Essential Plan 3&4	$11.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.79
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.10
Rate for Payer: Elderplan Medicare Advantage	$16.85
Rate for Payer: EmblemHealth Commercial	$16.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15.16
Rate for Payer: Fidelis Essential Plan Aliesa	$14.32
Rate for Payer: Fidelis Essential Plan QHP	$15.00
Rate for Payer: Fidelis Medicare Advantage	$16.85
Rate for Payer: Fidelis Qualified Health Plan	$15.00
Rate for Payer: Group Health Inc Commercial	$16.85
Rate for Payer: Group Health Inc Medicare	$16.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.85
Rate for Payer: Hamaspik Choice Inc Medicare	$16.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.11
Rate for Payer: Healthfirst Essential Plan	$18.25
Rate for Payer: Healthfirst Medicare Advantage	$16.85
Rate for Payer: Healthfirst QHP	$16.85
Rate for Payer: Humana Medicare	$17.19
Rate for Payer: Senior Whole Health Medicare Advantage	$16.85
Rate for Payer: United Healthcare Commercial	$21.33
Rate for Payer: United Healthcare Medicare Advantage	$16.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.11
Rate for Payer: Wellcare Medicare	$15.16

HC CMV ANTIBODY, IGM - CYTOMEGALOVIRUS ANTIBODY, IGM

Facility

$42.00

Service Code	CPT 86645
Hospital Charge Code	3028664502
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.85
Rate for Payer: Aetna Government	$16.85
Rate for Payer: Affinity Essential Plan 1&2	$11.79
Rate for Payer: Affinity Essential Plan 3&4	$11.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.79
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.10
Rate for Payer: Elderplan Medicare Advantage	$16.85
Rate for Payer: EmblemHealth Commercial	$16.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15.16
Rate for Payer: Fidelis Essential Plan Aliesa	$14.32
Rate for Payer: Fidelis Essential Plan QHP	$15.00
Rate for Payer: Fidelis Medicare Advantage	$16.85
Rate for Payer: Fidelis Qualified Health Plan	$15.00
Rate for Payer: Group Health Inc Commercial	$16.85
Rate for Payer: Group Health Inc Medicare	$16.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.85
Rate for Payer: Hamaspik Choice Inc Medicare	$16.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.11
Rate for Payer: Healthfirst Essential Plan	$18.25
Rate for Payer: Healthfirst Medicare Advantage	$16.85
Rate for Payer: Healthfirst QHP	$16.85
Rate for Payer: Humana Medicare	$17.19
Rate for Payer: Senior Whole Health Medicare Advantage	$16.85
Rate for Payer: United Healthcare Commercial	$21.33
Rate for Payer: United Healthcare Medicare Advantage	$16.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.11
Rate for Payer: Wellcare Medicare	$15.16

HC CMV ANTIBODY, IGM - CYTOMEGALOVIRUS ANTIBODY, IGM

Facility

$42.00

Service Code	CPT 86645
Hospital Charge Code	3028664502
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00

HC COAGULATION AND FIBRINOLYSIS, FUNCTIONAL ACTIVITY, NOT OTHERWISE SPECIFIED

Facility

$56.00

Service Code	CPT 85397
Hospital Charge Code	3058539701
Hospital Revenue Code	305
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$28.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.00

HC COAGULATION AND FIBRINOLYSIS, FUNCTIONAL ACTIVITY, NOT OTHERWISE SPECIFIED

Facility

$56.00

Service Code	CPT 85397
Hospital Charge Code	3058539701
Hospital Revenue Code	305
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$42.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.86
Rate for Payer: Aetna Government	$30.86
Rate for Payer: Affinity Essential Plan 1&2	$21.60
Rate for Payer: Affinity Essential Plan 3&4	$21.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.60
Rate for Payer: Brighton Health Commercial	$42.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.83
Rate for Payer: Elderplan Medicare Advantage	$30.86
Rate for Payer: EmblemHealth Commercial	$30.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.77
Rate for Payer: Fidelis Essential Plan Aliesa	$26.23
Rate for Payer: Fidelis Essential Plan QHP	$27.47
Rate for Payer: Fidelis Medicare Advantage	$30.86
Rate for Payer: Fidelis Qualified Health Plan	$27.47
Rate for Payer: Group Health Inc Commercial	$30.86
Rate for Payer: Group Health Inc Medicare	$30.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.86
Rate for Payer: Hamaspik Choice Inc Medicare	$30.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.49
Rate for Payer: Healthfirst Essential Plan	$21.35
Rate for Payer: Healthfirst Medicare Advantage	$30.86
Rate for Payer: Healthfirst QHP	$30.86
Rate for Payer: Humana Medicare	$31.48
Rate for Payer: Senior Whole Health Medicare Advantage	$30.86
Rate for Payer: United Healthcare Commercial	$29.06
Rate for Payer: United Healthcare Medicare Advantage	$30.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.49
Rate for Payer: Wellcare Medicare	$27.77

HC COAGULATION TIME, ACTIVATED - ACTIVATED CLOTTING TIME

Facility

$10.00

Service Code	CPT 85347
Hospital Charge Code	3058534701
Hospital Revenue Code	305
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$9.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.28
Rate for Payer: Aetna Government	$4.28
Rate for Payer: Affinity Essential Plan 1&2	$3.00
Rate for Payer: Affinity Essential Plan 3&4	$3.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: Elderplan Medicare Advantage	$4.28
Rate for Payer: EmblemHealth Commercial	$4.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.85
Rate for Payer: Fidelis Essential Plan Aliesa	$3.64
Rate for Payer: Fidelis Essential Plan QHP	$3.81
Rate for Payer: Fidelis Medicare Advantage	$4.28
Rate for Payer: Fidelis Qualified Health Plan	$3.81
Rate for Payer: Group Health Inc Commercial	$4.28
Rate for Payer: Group Health Inc Medicare	$4.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.28
Rate for Payer: Hamaspik Choice Inc Medicare	$4.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.28
Rate for Payer: Healthfirst Essential Plan	$9.63
Rate for Payer: Healthfirst Medicare Advantage	$4.28
Rate for Payer: Healthfirst QHP	$4.28
Rate for Payer: Humana Medicare	$4.37
Rate for Payer: Senior Whole Health Medicare Advantage	$4.28
Rate for Payer: United Healthcare Commercial	$5.39
Rate for Payer: United Healthcare Medicare Advantage	$4.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.28
Rate for Payer: Wellcare Medicare	$3.85

HC COAGULATION TIME, ACTIVATED - ACTIVATED CLOTTING TIME

Facility

$10.00

Service Code	CPT 85347
Hospital Charge Code	3058534701
Hospital Revenue Code	305
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC COAGULATION TIME, ACTIVATED - POCT ACTIVATED CLOTTING TIME

Facility

$10.00

Service Code	CPT 85347
Hospital Charge Code	3058534702
Hospital Revenue Code	305
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$9.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.28
Rate for Payer: Aetna Government	$4.28
Rate for Payer: Affinity Essential Plan 1&2	$3.00
Rate for Payer: Affinity Essential Plan 3&4	$3.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: Elderplan Medicare Advantage	$4.28
Rate for Payer: EmblemHealth Commercial	$4.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.85
Rate for Payer: Fidelis Essential Plan Aliesa	$3.64
Rate for Payer: Fidelis Essential Plan QHP	$3.81
Rate for Payer: Fidelis Medicare Advantage	$4.28
Rate for Payer: Fidelis Qualified Health Plan	$3.81
Rate for Payer: Group Health Inc Commercial	$4.28
Rate for Payer: Group Health Inc Medicare	$4.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.28
Rate for Payer: Hamaspik Choice Inc Medicare	$4.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.28
Rate for Payer: Healthfirst Essential Plan	$9.63
Rate for Payer: Healthfirst Medicare Advantage	$4.28
Rate for Payer: Healthfirst QHP	$4.28
Rate for Payer: Humana Medicare	$4.37
Rate for Payer: Senior Whole Health Medicare Advantage	$4.28
Rate for Payer: United Healthcare Commercial	$5.39
Rate for Payer: United Healthcare Medicare Advantage	$4.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.28
Rate for Payer: Wellcare Medicare	$3.85

HC COAGULATION TIME, ACTIVATED - POCT ACTIVATED CLOTTING TIME

Facility

$10.00

Service Code	CPT 85347
Hospital Charge Code	3058534702
Hospital Revenue Code	305
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

Know your out-of-pocket cost for care.

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