St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT - ERCP

Facility

$14,479.00

Service Code	CPT 43274 TC
Hospital Charge Code	3614327401
Hospital Revenue Code	361
Min. Negotiated Rate	$7,239.50
Max. Negotiated Rate	$7,239.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,239.50

HC ESOPHAGEAL MOTILITY STUDY, MANOMETRY - MOTILITY STUDY, ESOPHAGEAL

Facility

$1,470.00

Service Code	CPT 91010 TC
Hospital Charge Code	7509101001
Hospital Revenue Code	750
Min. Negotiated Rate	$97.42
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$97.42
Rate for Payer: Aetna Government	$97.42
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: EmblemHealth Commercial	$735.00
Rate for Payer: Group Health Inc Commercial	$735.00
Rate for Payer: Group Health Inc Medicare	$514.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00
Rate for Payer: Hamaspik Choice Inc Medicare	$735.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$178.24
Rate for Payer: United Healthcare Commercial	$1,113.00

HC ESOPHAGEAL MOTILITY STUDY, MANOMETRY - MOTILITY STUDY, ESOPHAGEAL

Facility

$1,470.00

Service Code	CPT 91010 TC
Hospital Charge Code	7509101001
Hospital Revenue Code	750
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION

Facility

$551.00

Service Code	CPT 43460
Hospital Charge Code	7504346001
Hospital Revenue Code	750
Min. Negotiated Rate	$192.85
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$247.89
Rate for Payer: Aetna Government	$247.89
Rate for Payer: Brighton Health Commercial	$413.25
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	$275.50
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	$238.80
Rate for Payer: United Healthcare Commercial	$1,496.00

HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION

Facility

$551.00

Service Code	CPT 43460
Hospital Charge Code	7504346001
Hospital Revenue Code	750
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Facility

$2,889.00

Service Code	CPT 43235
Hospital Charge Code	7504323501
Hospital Revenue Code	750
Min. Negotiated Rate	$1,444.50
Max. Negotiated Rate	$1,444.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,444.50

HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC

Facility

$2,889.00

Service Code	CPT 43235
Hospital Charge Code	7504323501
Hospital Revenue Code	750
Min. Negotiated Rate	$138.76
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,145.53
Rate for Payer: Aetna Government	$1,145.53
Rate for Payer: Affinity Essential Plan 1&2	$801.87
Rate for Payer: Affinity Essential Plan 3&4	$801.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$801.87
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,145.53
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	$1,145.53
Rate for Payer: EmblemHealth Commercial	$1,145.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,030.98
Rate for Payer: Fidelis Essential Plan Aliesa	$973.70
Rate for Payer: Fidelis Essential Plan QHP	$1,019.52
Rate for Payer: Fidelis Medicare Advantage	$1,145.53
Rate for Payer: Fidelis Qualified Health Plan	$1,019.52
Rate for Payer: Group Health Inc Commercial	$1,145.53
Rate for Payer: Group Health Inc Medicare	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicare	$503.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$138.76
Rate for Payer: Healthfirst Medicare Advantage	$973.70
Rate for Payer: Healthfirst QHP	$1,145.53
Rate for Payer: Humana Medicare	$1,168.44
Rate for Payer: Senior Whole Health Medicare Advantage	$1,145.53
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,145.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,145.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,088.25
Rate for Payer: Wellcare Medicare	$1,088.25

HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC - EGD

Facility

$2,889.00

Service Code	CPT 43235
Hospital Charge Code	7504323502
Hospital Revenue Code	750
Min. Negotiated Rate	$138.76
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,145.53
Rate for Payer: Aetna Government	$1,145.53
Rate for Payer: Affinity Essential Plan 1&2	$801.87
Rate for Payer: Affinity Essential Plan 3&4	$801.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$801.87
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,145.53
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	$1,145.53
Rate for Payer: EmblemHealth Commercial	$1,145.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,030.98
Rate for Payer: Fidelis Essential Plan Aliesa	$973.70
Rate for Payer: Fidelis Essential Plan QHP	$1,019.52
Rate for Payer: Fidelis Medicare Advantage	$1,145.53
Rate for Payer: Fidelis Qualified Health Plan	$1,019.52
Rate for Payer: Group Health Inc Commercial	$1,145.53
Rate for Payer: Group Health Inc Medicare	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,145.53
Rate for Payer: Hamaspik Choice Inc Medicare	$503.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$138.76
Rate for Payer: Healthfirst Medicare Advantage	$973.70
Rate for Payer: Healthfirst QHP	$1,145.53
Rate for Payer: Humana Medicare	$1,168.44
Rate for Payer: Senior Whole Health Medicare Advantage	$1,145.53
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,145.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,145.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,088.25
Rate for Payer: Wellcare Medicare	$1,088.25

HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC - EGD

Facility

$2,889.00

Service Code	CPT 43235
Hospital Charge Code	7504323502
Hospital Revenue Code	750
Min. Negotiated Rate	$1,444.50
Max. Negotiated Rate	$1,444.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,444.50

HC ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS - EGD

Facility

$4,716.00

Service Code	CPT 43237
Hospital Charge Code	7504323701
Hospital Revenue Code	750
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,317.78
Rate for Payer: Aetna Government	$2,317.78
Rate for Payer: Affinity Essential Plan 1&2	$1,622.45
Rate for Payer: Affinity Essential Plan 3&4	$1,622.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,622.45
Rate for Payer: Brighton Health Commercial	$955.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,317.78
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	$2,317.78
Rate for Payer: EmblemHealth Commercial	$2,317.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,086.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,970.11
Rate for Payer: Fidelis Essential Plan QHP	$2,062.82
Rate for Payer: Fidelis Medicare Advantage	$2,317.78
Rate for Payer: Fidelis Qualified Health Plan	$2,062.82
Rate for Payer: Group Health Inc Commercial	$2,317.78
Rate for Payer: Group Health Inc Medicare	$2,317.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,317.78
Rate for Payer: Hamaspik Choice Inc Medicare	$864.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$218.40
Rate for Payer: Healthfirst Medicare Advantage	$1,970.11
Rate for Payer: Healthfirst QHP	$2,317.78
Rate for Payer: Humana Medicare	$2,364.14
Rate for Payer: Senior Whole Health Medicare Advantage	$2,317.78
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,317.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,317.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,201.89
Rate for Payer: Wellcare Medicare	$2,201.89

HC ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS - EGD

Facility

$4,716.00

Service Code	CPT 43237
Hospital Charge Code	7504323701
Hospital Revenue Code	750
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$2,358.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.00

HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM - ESOPHAGOSCOPY

Facility

$4,716.00

Service Code	CPT 43231
Hospital Charge Code	7504323102
Hospital Revenue Code	750
Min. Negotiated Rate	$173.38
Max. Negotiated Rate	$3,537.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,317.78
Rate for Payer: Aetna Government	$2,317.78
Rate for Payer: Affinity Essential Plan 1&2	$1,622.45
Rate for Payer: Affinity Essential Plan 3&4	$1,622.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,622.45
Rate for Payer: Brighton Health Commercial	$3,537.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,317.78
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	$2,317.78
Rate for Payer: EmblemHealth Commercial	$2,317.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,086.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,970.11
Rate for Payer: Fidelis Essential Plan QHP	$2,062.82
Rate for Payer: Fidelis Medicare Advantage	$2,317.78
Rate for Payer: Fidelis Qualified Health Plan	$2,062.82
Rate for Payer: Group Health Inc Commercial	$2,317.78
Rate for Payer: Group Health Inc Medicare	$2,317.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,317.78
Rate for Payer: Hamaspik Choice Inc Medicare	$864.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.38
Rate for Payer: Healthfirst Medicare Advantage	$1,970.11
Rate for Payer: Healthfirst QHP	$2,317.78
Rate for Payer: Humana Medicare	$2,364.14
Rate for Payer: Senior Whole Health Medicare Advantage	$2,317.78
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,317.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,317.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,201.89
Rate for Payer: Wellcare Medicare	$2,201.89

HC ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM - ESOPHAGOSCOPY

Facility

$4,716.00

Service Code	CPT 43231
Hospital Charge Code	7504323102
Hospital Revenue Code	750
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$2,358.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.00

HC ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX - ESOPHAGOSCOPY

Facility

$4,716.00

Service Code	CPT 43232
Hospital Charge Code	7504323202
Hospital Revenue Code	750
Min. Negotiated Rate	$220.75
Max. Negotiated Rate	$3,537.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,317.78
Rate for Payer: Aetna Government	$2,317.78
Rate for Payer: Affinity Essential Plan 1&2	$1,622.45
Rate for Payer: Affinity Essential Plan 3&4	$1,622.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,622.45
Rate for Payer: Brighton Health Commercial	$3,537.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,317.78
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	$2,317.78
Rate for Payer: EmblemHealth Commercial	$2,317.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,086.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,970.11
Rate for Payer: Fidelis Essential Plan QHP	$2,062.82
Rate for Payer: Fidelis Medicare Advantage	$2,317.78
Rate for Payer: Fidelis Qualified Health Plan	$2,062.82
Rate for Payer: Group Health Inc Commercial	$2,317.78
Rate for Payer: Group Health Inc Medicare	$2,317.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,317.78
Rate for Payer: Hamaspik Choice Inc Medicare	$864.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$220.75
Rate for Payer: Healthfirst Medicare Advantage	$1,970.11
Rate for Payer: Healthfirst QHP	$2,317.78
Rate for Payer: Humana Medicare	$2,364.14
Rate for Payer: Senior Whole Health Medicare Advantage	$2,317.78
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,317.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,317.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,201.89
Rate for Payer: Wellcare Medicare	$2,201.89

HC ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX - ESOPHAGOSCOPY

Facility

$4,716.00

Service Code	CPT 43232
Hospital Charge Code	7504323202
Hospital Revenue Code	750
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$2,358.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,358.00

HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW

Facility

$551.00

Service Code	CPT 74220 TC
Hospital Charge Code	3207422001
Hospital Revenue Code	320
Min. Negotiated Rate	$51.19
Max. Negotiated Rate	$413.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.19
Rate for Payer: Aetna Government	$51.19
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.21
Rate for Payer: EmblemHealth Commercial	$71.13
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	$71.13
Rate for Payer: Healthfirst Essential Plan	$131.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.36

HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW

Facility

$551.00

Service Code	CPT 74220 TC
Hospital Charge Code	3207422001
Hospital Revenue Code	320
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC EUGLOBULIN LYSIS - EUGLOBULIN LYSIS TIME

Facility

$16.00

Service Code	CPT 85360
Hospital Charge Code	3058536001
Hospital Revenue Code	305
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00

HC EUGLOBULIN LYSIS - EUGLOBULIN LYSIS TIME

Facility

$16.00

Service Code	CPT 85360
Hospital Charge Code	3058536001
Hospital Revenue Code	305
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$15.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.41
Rate for Payer: Aetna Government	$8.41
Rate for Payer: Affinity Essential Plan 1&2	$5.89
Rate for Payer: Affinity Essential Plan 3&4	$5.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.89
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.03
Rate for Payer: Elderplan Medicare Advantage	$8.41
Rate for Payer: EmblemHealth Commercial	$8.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.57
Rate for Payer: Fidelis Essential Plan Aliesa	$7.15
Rate for Payer: Fidelis Essential Plan QHP	$7.48
Rate for Payer: Fidelis Medicare Advantage	$8.41
Rate for Payer: Fidelis Qualified Health Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$8.41
Rate for Payer: Group Health Inc Medicare	$8.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.41
Rate for Payer: Hamaspik Choice Inc Medicare	$8.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.67
Rate for Payer: Healthfirst Essential Plan	$15.01
Rate for Payer: Healthfirst Medicare Advantage	$8.41
Rate for Payer: Healthfirst QHP	$8.41
Rate for Payer: Humana Medicare	$8.58
Rate for Payer: Senior Whole Health Medicare Advantage	$8.41
Rate for Payer: United Healthcare Commercial	$10.65
Rate for Payer: United Healthcare Medicare Advantage	$8.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.67
Rate for Payer: Wellcare Medicare	$7.57

HC EVAL,NON-SPEECH GEN AUG/ALT COMMUN DEV

Facility

$436.00

Service Code	CPT 92605 GN
Hospital Charge Code	4449260501
Hospital Revenue Code	444
Min. Negotiated Rate	$218.00
Max. Negotiated Rate	$218.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.00

HC EVAL,NON-SPEECH GEN AUG/ALT COMMUN DEV

Facility

$436.00

Service Code	CPT 92605 GN
Hospital Charge Code	4449260501
Hospital Revenue Code	444
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$468.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.69
Rate for Payer: Aetna Government	$79.69
Rate for Payer: Affinity Essential Plan 1&2	$468.44
Rate for Payer: Affinity Essential Plan 3&4	$468.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$208.19
Rate for Payer: Amida Care Medicaid	$208.19
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.56
Rate for Payer: EmblemHealth Commercial	$218.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$468.44
Rate for Payer: EmblemHealth Essential Plan 3&4	$208.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$208.19
Rate for Payer: Fidelis Essential Plan Aliesa	$468.44
Rate for Payer: Fidelis Essential Plan QHP	$468.44
Rate for Payer: Fidelis Qualified Health Plan	$218.60
Rate for Payer: Group Health Inc Commercial	$218.00
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.19
Rate for Payer: Hamaspik Choice Inc Medicare	$208.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$208.19
Rate for Payer: Healthfirst Essential Plan	$468.44
Rate for Payer: Healthfirst QHP	$339.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$208.19
Rate for Payer: SOMOS Essential	$468.44
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$468.44
Rate for Payer: United Healthcare Essential Plan 3&4	$229.01
Rate for Payer: United Healthcare Medicaid	$208.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$208.19
Rate for Payer: Wellcare Medicare	$55.00

HC EVAL OF BRONCHOSPASM,PROLONGED - BRONCHIAL CHALLENGE W METHACHOLINE

Facility

$766.00

Service Code	CPT 94070
Hospital Charge Code	4609407001
Hospital Revenue Code	460
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EVAL OF BRONCHOSPASM,PROLONGED - BRONCHIAL CHALLENGE W METHACHOLINE

Facility

$766.00

Service Code	CPT 94070
Hospital Charge Code	4609407001
Hospital Revenue Code	460
Min. Negotiated Rate	$72.05
Max. Negotiated Rate	$612.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: Elderplan Medicare Advantage	$380.47
Rate for Payer: EmblemHealth Commercial	$380.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
Rate for Payer: Group Health Inc Commercial	$380.47
Rate for Payer: Group Health Inc Medicare	$380.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72.05
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$383.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR

Facility

$766.00

Service Code	CPT 94060
Hospital Charge Code	4609406001
Hospital Revenue Code	460
Min. Negotiated Rate	$383.00
Max. Negotiated Rate	$383.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.00

HC EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR

Facility

$766.00

Service Code	CPT 94060
Hospital Charge Code	4609406001
Hospital Revenue Code	460
Min. Negotiated Rate	$44.91
Max. Negotiated Rate	$612.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$574.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$520.88
Rate for Payer: Elderplan Medicare Advantage	$380.47
Rate for Payer: EmblemHealth Commercial	$380.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
Rate for Payer: Group Health Inc Commercial	$380.47
Rate for Payer: Group Health Inc Medicare	$380.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44.91
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$383.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

Know your out-of-pocket cost for care.

All Charges