St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED RENAL CYST ASPIRATION RIGHT

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701226
Hospital Revenue Code	350
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$1,582.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,087.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.16
Rate for Payer: Aetna Government	$70.16
Rate for Payer: Brighton Health Commercial	$1,483.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,582.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,345.04
Rate for Payer: EmblemHealth Commercial	$60.29
Rate for Payer: Group Health Inc Commercial	$989.00
Rate for Payer: Group Health Inc Medicare	$692.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00
Rate for Payer: Hamaspik Choice Inc Medicare	$989.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.29
Rate for Payer: Healthfirst Essential Plan	$236.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$105.00

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED RENAL CYST ASPIR BILAT CHG

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701221
Hospital Revenue Code	350
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$1,582.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,087.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.16
Rate for Payer: Aetna Government	$70.16
Rate for Payer: Brighton Health Commercial	$1,483.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,582.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,345.04
Rate for Payer: EmblemHealth Commercial	$60.29
Rate for Payer: Group Health Inc Commercial	$989.00
Rate for Payer: Group Health Inc Medicare	$692.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00
Rate for Payer: Hamaspik Choice Inc Medicare	$989.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.29
Rate for Payer: Healthfirst Essential Plan	$236.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$105.00

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED RENAL CYST ASPIR BILAT CHG

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701221
Hospital Revenue Code	350
Min. Negotiated Rate	$989.00
Max. Negotiated Rate	$989.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED RENAL CYST ASPIR LEFT CHG

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701222
Hospital Revenue Code	350
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$1,582.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,087.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.16
Rate for Payer: Aetna Government	$70.16
Rate for Payer: Brighton Health Commercial	$1,483.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,582.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,345.04
Rate for Payer: EmblemHealth Commercial	$60.29
Rate for Payer: Group Health Inc Commercial	$989.00
Rate for Payer: Group Health Inc Medicare	$692.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00
Rate for Payer: Hamaspik Choice Inc Medicare	$989.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.29
Rate for Payer: Healthfirst Essential Plan	$236.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$105.00

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED RENAL CYST ASPIR LEFT CHG

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701222
Hospital Revenue Code	350
Min. Negotiated Rate	$989.00
Max. Negotiated Rate	$989.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED RENAL CYST ASPIR RIGHT CHG

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701223
Hospital Revenue Code	350
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$1,582.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,087.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.16
Rate for Payer: Aetna Government	$70.16
Rate for Payer: Brighton Health Commercial	$1,483.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,582.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,345.04
Rate for Payer: EmblemHealth Commercial	$60.29
Rate for Payer: Group Health Inc Commercial	$989.00
Rate for Payer: Group Health Inc Medicare	$692.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00
Rate for Payer: Hamaspik Choice Inc Medicare	$989.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60.29
Rate for Payer: Healthfirst Essential Plan	$236.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$105.00

HC CT GUIDANCE NEEDLE PLACEMENT - CT GUIDED RENAL CYST ASPIR RIGHT CHG

Facility

$1,978.00

Service Code	CPT 77012 TC
Hospital Charge Code	3507701223
Hospital Revenue Code	350
Min. Negotiated Rate	$989.00
Max. Negotiated Rate	$989.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$989.00

HC CT GUIDANCE TISSUE ABLATION - CT GUIDED CRYOABLATION CHG

Facility

$1,822.00

Service Code	CPT 77013 TC
Hospital Charge Code	3507701302
Hospital Revenue Code	350
Min. Negotiated Rate	$911.00
Max. Negotiated Rate	$911.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$911.00

HC CT GUIDANCE TISSUE ABLATION - CT GUIDED CRYOABLATION CHG

Facility

$1,822.00

Service Code	CPT 77013 TC
Hospital Charge Code	3507701302
Hospital Revenue Code	350
Min. Negotiated Rate	$377.03
Max. Negotiated Rate	$1,457.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,002.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$377.03
Rate for Payer: Aetna Government	$377.03
Rate for Payer: Brighton Health Commercial	$1,366.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,457.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,238.96
Rate for Payer: EmblemHealth Commercial	$911.00
Rate for Payer: Group Health Inc Commercial	$911.00
Rate for Payer: Group Health Inc Medicare	$637.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$911.00
Rate for Payer: Hamaspik Choice Inc Medicare	$911.00
Rate for Payer: Healthfirst Essential Plan	$848.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$377.04

HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST

Facility

$551.00

Service Code	CPT 70492 TC
Hospital Charge Code	3517049201
Hospital Revenue Code	351
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT NECK TISSUE COMBO - CT SOFT TISSUE NECK W WO CONTRAST

Facility

$551.00

Service Code	CPT 70492 TC
Hospital Charge Code	3517049201
Hospital Revenue Code	351
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$214.20
Rate for Payer: Aetna Government	$214.20
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	$155.87
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	$155.87
Rate for Payer: Healthfirst Essential Plan	$545.15
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$242.29

HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST

Facility

$551.00

Service Code	CPT 70491 TC
Hospital Charge Code	3517049101
Hospital Revenue Code	351
Min. Negotiated Rate	$128.28
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.26
Rate for Payer: Aetna Government	$173.26
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	$128.28
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	$128.28
Rate for Payer: Healthfirst Essential Plan	$450.88
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$200.39

HC CT NECK TISSUE CONTRAST - CT SOFT TISSUE NECK W CONTRAST

Facility

$551.00

Service Code	CPT 70491 TC
Hospital Charge Code	3517049101
Hospital Revenue Code	351
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CTRL NOSEBLEED,ANTER,COMPLEX

Facility

$348.00

Service Code	CPT 30903
Hospital Charge Code	7613090301
Hospital Revenue Code	761
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$174.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.00

HC CTRL NOSEBLEED,ANTER,COMPLEX

Facility

$348.00

Service Code	CPT 30903
Hospital Charge Code	7613090301
Hospital Revenue Code	761
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$261.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
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	$157.49
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
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	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$69.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.54
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

HC CTRL NOSEBLEED,ANTER,SIMPLE

Facility

$330.00

Service Code	CPT 30901
Hospital Charge Code	3613090102
Hospital Revenue Code	361
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC CTRL NOSEBLEED,ANTER,SIMPLE

Facility

$330.00

Service Code	CPT 30901
Hospital Charge Code	3613090101
Hospital Revenue Code	361
Min. Negotiated Rate	$64.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
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	$157.49
Rate for Payer: EmblemHealth Commercial	$157.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
Rate for Payer: Group Health Inc Commercial	$157.49
Rate for Payer: Group Health Inc Medicare	$157.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$157.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64.93
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

HC CTRL NOSEBLEED,ANTER,SIMPLE

Facility

$330.00

Service Code	CPT 30901
Hospital Charge Code	3613090101
Hospital Revenue Code	361
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC CTRL NOSEBLEED,ANTER,SIMPLE

Facility

$330.00

Service Code	CPT 30901
Hospital Charge Code	3613090102
Hospital Revenue Code	361
Min. Negotiated Rate	$64.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
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	$157.49
Rate for Payer: EmblemHealth Commercial	$157.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
Rate for Payer: Group Health Inc Commercial	$157.49
Rate for Payer: Group Health Inc Medicare	$157.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$157.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64.93
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT

Facility

$330.00

Service Code	CPT 30905
Hospital Charge Code	3613090501
Hospital Revenue Code	361
Min. Negotiated Rate	$69.77
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
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	$157.49
Rate for Payer: EmblemHealth Commercial	$157.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
Rate for Payer: Group Health Inc Commercial	$157.49
Rate for Payer: Group Health Inc Medicare	$157.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$69.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$123.50
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT

Facility

$330.00

Service Code	CPT 30905
Hospital Charge Code	3613090501
Hospital Revenue Code	361
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST

Facility

$339.00

Service Code	CPT 72125 TC
Hospital Charge Code	3527212501
Hospital Revenue Code	352
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC CT SCAN,CERVICAL SPINE,W/O CONTRAST - CT CERVICAL SPINE WO CONTRAST

Facility

$339.00

Service Code	CPT 72125 TC
Hospital Charge Code	3527212501
Hospital Revenue Code	352
Min. Negotiated Rate	$89.64
Max. Negotiated Rate	$448.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$117.06
Rate for Payer: Aetna Government	$117.06
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$414.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$349.19
Rate for Payer: EmblemHealth Commercial	$89.64
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.64
Rate for Payer: Healthfirst Essential Plan	$448.43
Rate for Payer: United Healthcare Commercial	$155.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$199.30

HC CT SCAN CERV SP COMBO - CT CERVICAL SPINE W WO CONTRAST

Facility

$551.00

Service Code	CPT 72127 TC
Hospital Charge Code	3527212701
Hospital Revenue Code	352
Min. Negotiated Rate	$147.14
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$216.43
Rate for Payer: Aetna Government	$216.43
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	$147.14
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	$147.14
Rate for Payer: Healthfirst Essential Plan	$548.71
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$243.87

HC CT SCAN CERV SP COMBO - CT CERVICAL SPINE W WO CONTRAST

Facility

$551.00

Service Code	CPT 72127 TC
Hospital Charge Code	3527212701
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

Know your out-of-pocket cost for care.

All Charges