St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ECHO GUIDE FOR BIOPSY - US GUIDANCE NEEDLE PLACEMENT

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694232
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC ECHO GUIDE FOR BIOPSY - US GUIDED BIOPSY LYMPH NODE SUPERFICIAL

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694226
Hospital Revenue Code	402
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC ECHO GUIDE FOR BIOPSY - US GUIDED BIOPSY LYMPH NODE SUPERFICIAL

Facility

$1,144.00

Service Code	CPT 76942 TC
Hospital Charge Code	4027694226
Hospital Revenue Code	402
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.62
Rate for Payer: Aetna Government	$21.62
Rate for Payer: Brighton Health Commercial	$858.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$777.92
Rate for Payer: EmblemHealth Commercial	$30.60
Rate for Payer: Group Health Inc Commercial	$572.00
Rate for Payer: Group Health Inc Medicare	$400.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00
Rate for Payer: Hamaspik Choice Inc Medicare	$572.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30.60
Rate for Payer: Healthfirst Essential Plan	$287.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.95

HC ECHO HEART XTHORACIC,LIMITED

Facility

$817.00

Service Code	CPT 93308
Hospital Charge Code	4839330801
Hospital Revenue Code	483
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$612.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$653.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$555.56
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.95
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC ECHO HEART XTHORACIC,LIMITED

Facility

$817.00

Service Code	CPT 93308
Hospital Charge Code	4839330801
Hospital Revenue Code	483
Min. Negotiated Rate	$408.50
Max. Negotiated Rate	$408.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$408.50

HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS

Facility

$339.00

Service Code	CPT 76856 TC
Hospital Charge Code	4027685601
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS

Facility

$339.00

Service Code	CPT 76856 TC
Hospital Charge Code	4027685601
Hospital Revenue Code	402
Min. Negotiated Rate	$59.56
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.56
Rate for Payer: Aetna Government	$59.56
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$76.22
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	$76.22
Rate for Payer: Healthfirst Essential Plan	$181.42
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80.63

HC ECHO,SCROTUM & CONTENTS - US SCROTUM

Facility

$339.00

Service Code	CPT 76870 TC
Hospital Charge Code	4027687001
Hospital Revenue Code	402
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.04
Rate for Payer: Aetna Government	$28.04
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$73.42
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	$73.42
Rate for Payer: Healthfirst Essential Plan	$180.50
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80.22

HC ECHO,SCROTUM & CONTENTS - US SCROTUM

Facility

$339.00

Service Code	CPT 76870 TC
Hospital Charge Code	4027687001
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331204
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331204
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ CARDIOVERSION

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331210
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ CARDIOVERSION

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331210
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331208
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331208
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR & CARDIOVERSION

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331211
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR & CARDIOVERSION

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331211
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR & CONTRAST

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331209
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR & CONTRAST

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331209
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ CONTRAST

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331205
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ CONTRAST

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331205
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ DOPPLER & COLOR

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331206
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ DOPPLER & COLOR

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331206
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ DOPPLER, COLOR & CONTRAST

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331207
Hospital Revenue Code	483
Min. Negotiated Rate	$262.80
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$669.92
Rate for Payer: Aetna Government	$669.92
Rate for Payer: Affinity Essential Plan 1&2	$468.94
Rate for Payer: Affinity Essential Plan 3&4	$468.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$468.94
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$669.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: Elderplan Medicare Advantage	$669.92
Rate for Payer: EmblemHealth Commercial	$669.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$602.93
Rate for Payer: Fidelis Essential Plan Aliesa	$569.43
Rate for Payer: Fidelis Essential Plan QHP	$596.23
Rate for Payer: Fidelis Medicare Advantage	$669.92
Rate for Payer: Fidelis Qualified Health Plan	$596.23
Rate for Payer: Group Health Inc Commercial	$669.92
Rate for Payer: Group Health Inc Medicare	$669.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$669.92
Rate for Payer: Hamaspik Choice Inc Medicare	$669.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$262.80
Rate for Payer: Healthfirst Medicare Advantage	$569.43
Rate for Payer: Healthfirst QHP	$669.92
Rate for Payer: Humana Medicare	$683.32
Rate for Payer: Senior Whole Health Medicare Advantage	$669.92
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$669.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$669.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$636.42
Rate for Payer: Wellcare Medicare	$636.42

HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ DOPPLER, COLOR & CONTRAST

Facility

$1,458.00

Service Code	CPT 93312
Hospital Charge Code	4839331207
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

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