St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ELECTROCARDIOGRAM, TRACING - ECG 12-LEAD

Facility

$166.00

Service Code	CPT 93005
Hospital Charge Code	7309300502
Hospital Revenue Code	730
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$132.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.58
Rate for Payer: Aetna Government	$72.58
Rate for Payer: Affinity Essential Plan 1&2	$50.81
Rate for Payer: Affinity Essential Plan 3&4	$50.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$50.81
Rate for Payer: Brighton Health Commercial	$124.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$72.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$132.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.88
Rate for Payer: Elderplan Medicare Advantage	$72.58
Rate for Payer: EmblemHealth Commercial	$72.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65.32
Rate for Payer: Fidelis Essential Plan Aliesa	$61.69
Rate for Payer: Fidelis Essential Plan QHP	$64.60
Rate for Payer: Fidelis Medicare Advantage	$72.58
Rate for Payer: Fidelis Qualified Health Plan	$64.60
Rate for Payer: Group Health Inc Commercial	$72.58
Rate for Payer: Group Health Inc Medicare	$72.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.58
Rate for Payer: Hamaspik Choice Inc Medicare	$72.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.60
Rate for Payer: Healthfirst Medicare Advantage	$61.69
Rate for Payer: Healthfirst QHP	$72.58
Rate for Payer: Humana Medicare	$74.03
Rate for Payer: Senior Whole Health Medicare Advantage	$72.58
Rate for Payer: United Healthcare Commercial	$101.00
Rate for Payer: United Healthcare Medicare Advantage	$72.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68.95
Rate for Payer: Wellcare Medicare	$68.95

HC ELECTROCARDIOGRAM, TRACING - ECG 12-LEAD

Facility

$166.00

Service Code	CPT 93005
Hospital Charge Code	7309300502
Hospital Revenue Code	730
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$83.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00

HC ELECTROCOCHLEOGRAPHY

Facility

$419.00

Service Code	CPT 92584
Hospital Charge Code	4719258401
Hospital Revenue Code	471
Min. Negotiated Rate	$122.32
Max. Negotiated Rate	$335.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.17
Rate for Payer: Aetna Government	$191.17
Rate for Payer: Affinity Essential Plan 1&2	$133.82
Rate for Payer: Affinity Essential Plan 3&4	$133.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$133.82
Rate for Payer: Brighton Health Commercial	$314.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$191.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.92
Rate for Payer: Elderplan Medicare Advantage	$191.17
Rate for Payer: EmblemHealth Commercial	$191.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$172.05
Rate for Payer: Fidelis Essential Plan Aliesa	$162.49
Rate for Payer: Fidelis Essential Plan QHP	$170.14
Rate for Payer: Fidelis Medicare Advantage	$191.17
Rate for Payer: Fidelis Qualified Health Plan	$170.14
Rate for Payer: Group Health Inc Commercial	$191.17
Rate for Payer: Group Health Inc Medicare	$191.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.17
Rate for Payer: Hamaspik Choice Inc Medicare	$191.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$122.32
Rate for Payer: Healthfirst Medicare Advantage	$162.49
Rate for Payer: Healthfirst QHP	$191.17
Rate for Payer: Humana Medicare	$194.99
Rate for Payer: Senior Whole Health Medicare Advantage	$191.17
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$191.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.61
Rate for Payer: Wellcare Medicare	$181.61

HC ELECTROCOCHLEOGRAPHY

Facility

$419.00

Service Code	CPT 92584
Hospital Charge Code	4719258401
Hospital Revenue Code	471
Min. Negotiated Rate	$209.50
Max. Negotiated Rate	$209.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50

HC ELECTRO HEARINGAID TEST, BOTH

Facility

$212.00

Service Code	CPT 92595
Hospital Charge Code	4719259501
Hospital Revenue Code	471
Min. Negotiated Rate	$106.00
Max. Negotiated Rate	$106.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.00

HC ELECTRO HEARINGAID TEST, BOTH

Facility

$212.00

Service Code	CPT 92595
Hospital Charge Code	4719259501
Hospital Revenue Code	471
Min. Negotiated Rate	$38.99
Max. Negotiated Rate	$169.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.99
Rate for Payer: Aetna Government	$38.99
Rate for Payer: Brighton Health Commercial	$159.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$169.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.16
Rate for Payer: EmblemHealth Commercial	$106.00
Rate for Payer: Group Health Inc Commercial	$106.00
Rate for Payer: Group Health Inc Medicare	$74.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.00
Rate for Payer: Hamaspik Choice Inc Medicare	$106.00
Rate for Payer: United Healthcare Commercial	$158.00

HC ELECTRO HEARING AID TEST, ONE

Facility

$141.00

Service Code	CPT 92594
Hospital Charge Code	4719259401
Hospital Revenue Code	471
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.50

HC ELECTRO HEARING AID TEST, ONE

Facility

$141.00

Service Code	CPT 92594
Hospital Charge Code	4719259401
Hospital Revenue Code	471
Min. Negotiated Rate	$18.19
Max. Negotiated Rate	$158.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.19
Rate for Payer: Aetna Government	$18.19
Rate for Payer: Brighton Health Commercial	$105.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.88
Rate for Payer: EmblemHealth Commercial	$70.50
Rate for Payer: Group Health Inc Commercial	$70.50
Rate for Payer: Group Health Inc Medicare	$49.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.50
Rate for Payer: Hamaspik Choice Inc Medicare	$70.50
Rate for Payer: United Healthcare Commercial	$158.00

HC ELECTROLYTE PANEL - BUNDLED CHARGE

Facility

$17.00

Service Code	CPT 80051
Hospital Charge Code	3018005101
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50

HC ELECTROLYTE PANEL - BUNDLED CHARGE

Facility

$17.00

Service Code	CPT 80051
Hospital Charge Code	3018005101
Hospital Revenue Code	301
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$13.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.01
Rate for Payer: Aetna Government	$7.01
Rate for Payer: Affinity Essential Plan 1&2	$4.91
Rate for Payer: Affinity Essential Plan 3&4	$4.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.91
Rate for Payer: Brighton Health Commercial	$12.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.04
Rate for Payer: Elderplan Medicare Advantage	$7.01
Rate for Payer: EmblemHealth Commercial	$7.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.31
Rate for Payer: Fidelis Essential Plan Aliesa	$5.96
Rate for Payer: Fidelis Essential Plan QHP	$6.24
Rate for Payer: Fidelis Medicare Advantage	$7.01
Rate for Payer: Fidelis Qualified Health Plan	$6.24
Rate for Payer: Group Health Inc Commercial	$7.01
Rate for Payer: Group Health Inc Medicare	$7.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.01
Rate for Payer: Hamaspik Choice Inc Medicare	$7.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.10
Rate for Payer: Healthfirst Essential Plan	$13.72
Rate for Payer: Healthfirst Medicare Advantage	$7.01
Rate for Payer: Healthfirst QHP	$7.01
Rate for Payer: Humana Medicare	$7.15
Rate for Payer: Senior Whole Health Medicare Advantage	$7.01
Rate for Payer: United Healthcare Commercial	$8.88
Rate for Payer: United Healthcare Medicare Advantage	$7.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.10
Rate for Payer: Wellcare Medicare	$6.31

HC ELECTRON MICROSCOPY, DIAGNOSTIC

Facility

$137.00

Service Code	CPT 88348
Hospital Charge Code	3108834801
Hospital Revenue Code	310
Min. Negotiated Rate	$75.35
Max. Negotiated Rate	$1,018.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$998.10
Rate for Payer: Aetna Government	$998.10
Rate for Payer: Affinity Essential Plan 1&2	$698.67
Rate for Payer: Affinity Essential Plan 3&4	$698.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$698.67
Rate for Payer: Brighton Health Commercial	$998.10
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$998.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$734.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$617.91
Rate for Payer: Elderplan Medicare Advantage	$998.10
Rate for Payer: EmblemHealth Commercial	$569.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$898.29
Rate for Payer: Fidelis Essential Plan Aliesa	$848.38
Rate for Payer: Fidelis Essential Plan QHP	$888.31
Rate for Payer: Fidelis Medicare Advantage	$998.10
Rate for Payer: Fidelis Qualified Health Plan	$888.31
Rate for Payer: Group Health Inc Commercial	$998.10
Rate for Payer: Group Health Inc Medicare	$998.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$998.10
Rate for Payer: Hamaspik Choice Inc Medicare	$998.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$569.32
Rate for Payer: Healthfirst Medicare Advantage	$998.10
Rate for Payer: Healthfirst QHP	$998.10
Rate for Payer: Humana Medicare	$1,018.06
Rate for Payer: Senior Whole Health Medicare Advantage	$998.10
Rate for Payer: United Healthcare Medicare Advantage	$998.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$998.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$948.20
Rate for Payer: Wellcare Medicare	$898.29

HC ELECTRON MICROSCOPY, DIAGNOSTIC

Facility

$137.00

Service Code	CPT 88348
Hospital Charge Code	3108834801
Hospital Revenue Code	310
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$68.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.50

HC ELECTROPHORETIC TEST - IMMUNOFIXATION ELECTROPHORESIS

Facility

$153.00

Service Code	CPT 82664
Hospital Charge Code	3018266401
Hospital Revenue Code	301
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$114.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.50
Rate for Payer: Aetna Government	$61.50
Rate for Payer: Affinity Essential Plan 1&2	$43.05
Rate for Payer: Affinity Essential Plan 3&4	$43.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.05
Rate for Payer: Brighton Health Commercial	$114.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$61.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.16
Rate for Payer: Elderplan Medicare Advantage	$61.50
Rate for Payer: EmblemHealth Commercial	$61.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55.35
Rate for Payer: Fidelis Essential Plan Aliesa	$52.27
Rate for Payer: Fidelis Essential Plan QHP	$54.73
Rate for Payer: Fidelis Medicare Advantage	$61.50
Rate for Payer: Fidelis Qualified Health Plan	$54.73
Rate for Payer: Group Health Inc Commercial	$61.50
Rate for Payer: Group Health Inc Medicare	$61.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.50
Rate for Payer: Hamaspik Choice Inc Medicare	$61.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61.50
Rate for Payer: Healthfirst Medicare Advantage	$61.50
Rate for Payer: Healthfirst QHP	$61.50
Rate for Payer: Humana Medicare	$62.73
Rate for Payer: Senior Whole Health Medicare Advantage	$61.50
Rate for Payer: United Healthcare Commercial	$43.52
Rate for Payer: United Healthcare Medicare Advantage	$61.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.42
Rate for Payer: Wellcare Medicare	$55.35

HC ELECTROPHORETIC TEST - IMMUNOFIXATION ELECTROPHORESIS

Facility

$153.00

Service Code	CPT 82664
Hospital Charge Code	3018266401
Hospital Revenue Code	301
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.50

HC EMBOLIZATION/OCCLUSION, PERC. EXTRACRANIAL

Facility

$30,010.00

Service Code	CPT 61626 TC
Hospital Charge Code	3616162601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,009.71
Max. Negotiated Rate	$22,507.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,009.71
Rate for Payer: Aetna Government	$1,009.71
Rate for Payer: Brighton Health Commercial	$22,507.50
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	$15,005.00
Rate for Payer: Group Health Inc Commercial	$15,005.00
Rate for Payer: Group Health Inc Medicare	$10,503.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15,005.00
Rate for Payer: United Healthcare Commercial	$3,190.00

HC EMBOLIZATION/OCCLUSION, PERC. EXTRACRANIAL

Facility

$30,010.00

Service Code	CPT 61626 TC
Hospital Charge Code	3616162601
Hospital Revenue Code	361
Min. Negotiated Rate	$15,005.00
Max. Negotiated Rate	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00

HC EMBOLIZATION/OCCLUSION, PERC. INTRACRANIAL

Facility

$30,010.00

Service Code	CPT 61624 TC
Hospital Charge Code	3616162401
Hospital Revenue Code	361
Min. Negotiated Rate	$15,005.00
Max. Negotiated Rate	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00

HC EMBOLIZATION/OCCLUSION, PERC. INTRACRANIAL

Facility

$30,010.00

Service Code	CPT 61624 TC
Hospital Charge Code	3616162401
Hospital Revenue Code	361
Min. Negotiated Rate	$1,389.31
Max. Negotiated Rate	$22,507.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,505.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,389.31
Rate for Payer: Aetna Government	$1,389.31
Rate for Payer: Brighton Health Commercial	$22,507.50
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	$15,005.00
Rate for Payer: Group Health Inc Commercial	$15,005.00
Rate for Payer: Group Health Inc Medicare	$10,503.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15,005.00
Rate for Payer: United Healthcare Commercial	$3,190.00

HC EMB/THROMB, AXILLARY,BRACHIAL,IMM SUBCLAV, ARM INCSN

Facility

$13,920.00

Service Code	CPT 34101 TC
Hospital Charge Code	3613410101
Hospital Revenue Code	361
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC EMB/THROMB, AXILLARY,BRACHIAL,IMM SUBCLAV, ARM INCSN

Facility

$13,920.00

Service Code	CPT 34101 TC
Hospital Charge Code	3613410101
Hospital Revenue Code	361
Min. Negotiated Rate	$684.64
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$684.64
Rate for Payer: Aetna Government	$684.64
Rate for Payer: Brighton Health Commercial	$10,440.00
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	$6,960.00
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC EMB/THROM, FEMOR, AORT-IL ART, LEG

Facility

$13,920.00

Service Code	CPT 34201 TC
Hospital Charge Code	3613420101
Hospital Revenue Code	361
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC EMB/THROM, FEMOR, AORT-IL ART, LEG

Facility

$13,920.00

Service Code	CPT 34201 TC
Hospital Charge Code	3613420101
Hospital Revenue Code	361
Min. Negotiated Rate	$1,174.65
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,174.65
Rate for Payer: Aetna Government	$1,174.65
Rate for Payer: Brighton Health Commercial	$10,440.00
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	$6,960.00
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC EMB/THROM, RENAL,CELIAC,AORTOILIAC, ABDOM INCSN

Facility

$13,920.00

Service Code	CPT 34151 TC
Hospital Charge Code	3613415101
Hospital Revenue Code	361
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$10,440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,656.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,592.01
Rate for Payer: Aetna Government	$1,592.01
Rate for Payer: Brighton Health Commercial	$10,440.00
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	$6,960.00
Rate for Payer: Group Health Inc Commercial	$6,960.00
Rate for Payer: Group Health Inc Medicare	$4,872.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.00
Rate for Payer: United Healthcare Commercial	$1,496.00

HC EMB/THROM, RENAL,CELIAC,AORTOILIAC, ABDOM INCSN

Facility

$13,920.00

Service Code	CPT 34151 TC
Hospital Charge Code	3613415101
Hospital Revenue Code	361
Min. Negotiated Rate	$6,960.00
Max. Negotiated Rate	$6,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.00

HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB

Facility

$712.00

Service Code	CPT 99281
Hospital Charge Code	4509928101
Hospital Revenue Code	450
Min. Negotiated Rate	$356.00
Max. Negotiated Rate	$356.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.00

Know your out-of-pocket cost for care.

All Charges