St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC FLUORESCENT ANTIBODY; SCREEN - ANTI-MYELIN ASSOC GLYCOP

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625504
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; SCREEN - CRITHIDIA

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625501
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; SCREEN - CRITHIDIA

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625501
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; SCREEN - ENDOMYSIAL ANTIBODY

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625505
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; SCREEN - ENDOMYSIAL ANTIBODY

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625505
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; SCREEN - RETICULIN ANTIBODIES

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625503
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; SCREEN - RETICULIN ANTIBODIES

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625503
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; SCREEN - RICKETTSIA ANTIBODY

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625502
Hospital Revenue Code	302
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.25
Rate for Payer: Healthfirst Essential Plan	$11.81
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.25
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; SCREEN - RICKETTSIA ANTIBODY

Facility

$30.00

Service Code	CPT 86255
Hospital Charge Code	3028625502
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; TITER - ANTI-HU ANTIBODY

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625604
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; TITER - ANTI-HU ANTIBODY

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625604
Hospital Revenue Code	302
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.45
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; TITER - ANTI-MYELIN ASSOC GLY

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625603
Hospital Revenue Code	302
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.45
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; TITER - ANTI-MYELIN ASSOC GLY

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625603
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; TITER - ANTI-SMOOTH MUSCLE ANTIBODY TITER

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625602
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUORESCENT ANTIBODY; TITER - ANTI-SMOOTH MUSCLE ANTIBODY TITER

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625602
Hospital Revenue Code	302
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.45
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; TITER - EACH ANTIBODY

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625601
Hospital Revenue Code	302
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.23
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.45
Rate for Payer: Wellcare Medicare	$10.85

HC FLUORESCENT ANTIBODY; TITER - EACH ANTIBODY

Facility

$30.00

Service Code	CPT 86256
Hospital Charge Code	3028625601
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC FLUOROGUIDE FOR VEIN DEVICE - FL GUIDED VENOUS ACCESS

Facility

$329.00

Service Code	CPT 77001 TC
Hospital Charge Code	3207700101
Hospital Revenue Code	320
Min. Negotiated Rate	$40.17
Max. Negotiated Rate	$263.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$180.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$40.17
Rate for Payer: Aetna Government	$40.17
Rate for Payer: Brighton Health Commercial	$246.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$263.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$223.72
Rate for Payer: EmblemHealth Commercial	$83.00
Rate for Payer: Group Health Inc Commercial	$164.50
Rate for Payer: Group Health Inc Medicare	$115.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$83.00
Rate for Payer: Healthfirst Essential Plan	$166.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.16

HC FLUOROGUIDE FOR VEIN DEVICE - FL GUIDED VENOUS ACCESS

Facility

$329.00

Service Code	CPT 77001 TC
Hospital Charge Code	3207700101
Hospital Revenue Code	320
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50

HC FLUOROSCOPY <1 HR PHYS/QHP - FL LESS THAN 1 HOUR INTRAOPERATIVE

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600004
Hospital Revenue Code	320
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.27
Rate for Payer: Aetna Government	$30.27
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.40
Rate for Payer: EmblemHealth Commercial	$29.56
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.56
Rate for Payer: Healthfirst Essential Plan	$113.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.37

HC FLUOROSCOPY <1 HR PHYS/QHP - FL LESS THAN 1 HOUR INTRAOPERATIVE

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600004
Hospital Revenue Code	320
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC FLUOROSCOPY <1 HR PHYS/QHP - FL SNIFF TEST

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600003
Hospital Revenue Code	320
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC FLUOROSCOPY <1 HR PHYS/QHP - FL SNIFF TEST

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600003
Hospital Revenue Code	320
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.27
Rate for Payer: Aetna Government	$30.27
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.40
Rate for Payer: EmblemHealth Commercial	$29.56
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.56
Rate for Payer: Healthfirst Essential Plan	$113.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.37

HC FLUOROSCOPY <1 HR PHYS/QHP - IR CVC REPOSITION W FL GUIDANCE

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600001
Hospital Revenue Code	320
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC FLUOROSCOPY <1 HR PHYS/QHP - IR CVC REPOSITION W FL GUIDANCE

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600001
Hospital Revenue Code	320
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$528.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.27
Rate for Payer: Aetna Government	$30.27
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$178.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$150.40
Rate for Payer: EmblemHealth Commercial	$29.56
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.56
Rate for Payer: Healthfirst Essential Plan	$113.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.37

Know your out-of-pocket cost for care.

All Charges