St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600002
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 CHG

Facility

$705.00

Service Code	CPT 76000 TC
Hospital Charge Code	3207600002
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 FLUORSCOPIC GUIDANCE SPINAL INJECTION - IR DISC ASPIRATION

Facility

$1,144.00

Service Code	CPT 77003 TC
Hospital Charge Code	3207700301
Hospital Revenue Code	320
Min. Negotiated Rate	$39.82
Max. Negotiated Rate	$915.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.38
Rate for Payer: Aetna Government	$43.38
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	$78.46
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	$78.46
Rate for Payer: Healthfirst Essential Plan	$89.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39.82

HC FLUORSCOPIC GUIDANCE SPINAL INJECTION - IR DISC ASPIRATION

Facility

$1,144.00

Service Code	CPT 77003 TC
Hospital Charge Code	3207700301
Hospital Revenue Code	320
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$572.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.00

HC FMR1 GENE DETECTION - CHROMOSOME ANALYSIS, FRAG X DNA

Facility

$142.00

Service Code	CPT 81243
Hospital Charge Code	3108124301
Hospital Revenue Code	310
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$71.00

HC FMR1 GENE DETECTION - CHROMOSOME ANALYSIS, FRAG X DNA

Facility

$142.00

Service Code	CPT 81243
Hospital Charge Code	3108124301
Hospital Revenue Code	310
Min. Negotiated Rate	$39.93
Max. Negotiated Rate	$113.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.04
Rate for Payer: Aetna Government	$57.04
Rate for Payer: Affinity Essential Plan 1&2	$39.93
Rate for Payer: Affinity Essential Plan 3&4	$39.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$39.93
Rate for Payer: Brighton Health Commercial	$57.04
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$57.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$113.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$96.56
Rate for Payer: Elderplan Medicare Advantage	$57.04
Rate for Payer: EmblemHealth Commercial	$57.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$51.34
Rate for Payer: Fidelis Essential Plan Aliesa	$48.48
Rate for Payer: Fidelis Essential Plan QHP	$50.77
Rate for Payer: Fidelis Medicare Advantage	$57.04
Rate for Payer: Fidelis Qualified Health Plan	$50.77
Rate for Payer: Group Health Inc Commercial	$57.04
Rate for Payer: Group Health Inc Medicare	$57.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.04
Rate for Payer: Hamaspik Choice Inc Medicare	$57.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$57.04
Rate for Payer: Healthfirst Medicare Advantage	$57.04
Rate for Payer: Healthfirst QHP	$57.04
Rate for Payer: Humana Medicare	$58.18
Rate for Payer: Senior Whole Health Medicare Advantage	$57.04
Rate for Payer: United Healthcare Medicare Advantage	$57.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$54.19
Rate for Payer: Wellcare Medicare	$51.34

HC FNA BIOPSY W/CT GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10009
Hospital Charge Code	3611000901
Hospital Revenue Code	361
Min. Negotiated Rate	$119.79
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$859.66
Rate for Payer: Aetna Government	$859.66
Rate for Payer: Affinity Essential Plan 1&2	$601.76
Rate for Payer: Affinity Essential Plan 3&4	$601.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$601.76
Rate for Payer: Brighton Health Commercial	$1,385.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$859.66
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	$859.66
Rate for Payer: EmblemHealth Commercial	$859.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$773.69
Rate for Payer: Fidelis Essential Plan Aliesa	$730.71
Rate for Payer: Fidelis Essential Plan QHP	$765.10
Rate for Payer: Fidelis Medicare Advantage	$859.66
Rate for Payer: Fidelis Qualified Health Plan	$765.10
Rate for Payer: Group Health Inc Commercial	$859.66
Rate for Payer: Group Health Inc Medicare	$859.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$859.66
Rate for Payer: Hamaspik Choice Inc Medicare	$377.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119.79
Rate for Payer: Healthfirst Medicare Advantage	$730.71
Rate for Payer: Healthfirst QHP	$859.66
Rate for Payer: Humana Medicare	$876.85
Rate for Payer: Senior Whole Health Medicare Advantage	$859.66
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$859.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$859.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$816.68
Rate for Payer: Wellcare Medicare	$816.68

HC FNA BIOPSY W/CT GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10009
Hospital Charge Code	3611000901
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC FNA BIOPSY W/CT GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10010
Hospital Charge Code	3611001001
Hospital Revenue Code	361
Min. Negotiated Rate	$70.47
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.47
Rate for Payer: Aetna Government	$70.47
Rate for Payer: Brighton Health Commercial	$692.25
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	$461.50
Rate for Payer: Group Health Inc Commercial	$461.50
Rate for Payer: Group Health Inc Medicare	$323.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50
Rate for Payer: Hamaspik Choice Inc Medicare	$461.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$81.08
Rate for Payer: United Healthcare Commercial	$1,113.00

HC FNA BIOPSY W/CT GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10010
Hospital Charge Code	3611001001
Hospital Revenue Code	361
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$461.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50

HC FNA BIOPSY W/FLUOR GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10007
Hospital Charge Code	3611000701
Hospital Revenue Code	361
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$859.66
Rate for Payer: Aetna Government	$859.66
Rate for Payer: Affinity Essential Plan 1&2	$601.76
Rate for Payer: Affinity Essential Plan 3&4	$601.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$601.76
Rate for Payer: Brighton Health Commercial	$1,385.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$859.66
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	$859.66
Rate for Payer: EmblemHealth Commercial	$859.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$773.69
Rate for Payer: Fidelis Essential Plan Aliesa	$730.71
Rate for Payer: Fidelis Essential Plan QHP	$765.10
Rate for Payer: Fidelis Medicare Advantage	$859.66
Rate for Payer: Fidelis Qualified Health Plan	$765.10
Rate for Payer: Group Health Inc Commercial	$859.66
Rate for Payer: Group Health Inc Medicare	$859.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$859.66
Rate for Payer: Hamaspik Choice Inc Medicare	$228.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$100.64
Rate for Payer: Healthfirst Medicare Advantage	$730.71
Rate for Payer: Healthfirst QHP	$859.66
Rate for Payer: Humana Medicare	$876.85
Rate for Payer: Senior Whole Health Medicare Advantage	$859.66
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$859.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$859.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$816.68
Rate for Payer: Wellcare Medicare	$816.68

HC FNA BIOPSY W/FLUOR GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10007
Hospital Charge Code	3611000701
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC FNA BIOPSY W/FLUOR GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10008
Hospital Charge Code	3611000801
Hospital Revenue Code	361
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$461.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50

HC FNA BIOPSY W/FLUOR GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10008
Hospital Charge Code	3611000801
Hospital Revenue Code	361
Min. Negotiated Rate	$52.04
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.04
Rate for Payer: Aetna Government	$52.04
Rate for Payer: Brighton Health Commercial	$692.25
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	$461.50
Rate for Payer: Group Health Inc Commercial	$461.50
Rate for Payer: Group Health Inc Medicare	$323.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50
Rate for Payer: Hamaspik Choice Inc Medicare	$461.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$58.69
Rate for Payer: United Healthcare Commercial	$1,113.00

HC FNA BIOPSY W/MR GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10011
Hospital Charge Code	3611001101
Hospital Revenue Code	361
Min. Negotiated Rate	$377.60
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$859.66
Rate for Payer: Aetna Government	$859.66
Rate for Payer: Affinity Essential Plan 1&2	$601.76
Rate for Payer: Affinity Essential Plan 3&4	$601.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$601.76
Rate for Payer: Brighton Health Commercial	$1,385.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$859.66
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	$859.66
Rate for Payer: EmblemHealth Commercial	$859.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$773.69
Rate for Payer: Fidelis Essential Plan Aliesa	$730.71
Rate for Payer: Fidelis Essential Plan QHP	$765.10
Rate for Payer: Fidelis Medicare Advantage	$859.66
Rate for Payer: Fidelis Qualified Health Plan	$765.10
Rate for Payer: Group Health Inc Commercial	$859.66
Rate for Payer: Group Health Inc Medicare	$859.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$859.66
Rate for Payer: Hamaspik Choice Inc Medicare	$377.60
Rate for Payer: Healthfirst Medicare Advantage	$730.71
Rate for Payer: Healthfirst QHP	$859.66
Rate for Payer: Humana Medicare	$876.85
Rate for Payer: Senior Whole Health Medicare Advantage	$859.66
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$859.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$859.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$816.68
Rate for Payer: Wellcare Medicare	$816.68

HC FNA BIOPSY W/MR GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10011
Hospital Charge Code	3611001101
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC FNA BIOPSY W/MR GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10012
Hospital Charge Code	3611001201
Hospital Revenue Code	361
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$461.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50

HC FNA BIOPSY W/MR GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10012
Hospital Charge Code	3611001201
Hospital Revenue Code	361
Min. Negotiated Rate	$234.84
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$234.84
Rate for Payer: Aetna Government	$234.84
Rate for Payer: Brighton Health Commercial	$692.25
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	$461.50
Rate for Payer: Group Health Inc Commercial	$461.50
Rate for Payer: Group Health Inc Medicare	$323.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50
Rate for Payer: Hamaspik Choice Inc Medicare	$461.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC FNA BIOPSY W/US GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10005
Hospital Charge Code	3611000501
Hospital Revenue Code	361
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$923.50

HC FNA BIOPSY W/US GDN 1ST LESION

Facility

$1,847.00

Service Code	CPT 10005
Hospital Charge Code	3611000501
Hospital Revenue Code	361
Min. Negotiated Rate	$81.53
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$859.66
Rate for Payer: Aetna Government	$859.66
Rate for Payer: Affinity Essential Plan 1&2	$601.76
Rate for Payer: Affinity Essential Plan 3&4	$601.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$601.76
Rate for Payer: Brighton Health Commercial	$1,385.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$859.66
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	$859.66
Rate for Payer: EmblemHealth Commercial	$859.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$773.69
Rate for Payer: Fidelis Essential Plan Aliesa	$730.71
Rate for Payer: Fidelis Essential Plan QHP	$765.10
Rate for Payer: Fidelis Medicare Advantage	$859.66
Rate for Payer: Fidelis Qualified Health Plan	$765.10
Rate for Payer: Group Health Inc Commercial	$859.66
Rate for Payer: Group Health Inc Medicare	$859.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$859.66
Rate for Payer: Hamaspik Choice Inc Medicare	$377.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$81.53
Rate for Payer: Healthfirst Medicare Advantage	$730.71
Rate for Payer: Healthfirst QHP	$859.66
Rate for Payer: Humana Medicare	$876.85
Rate for Payer: Senior Whole Health Medicare Advantage	$859.66
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$859.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$859.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$816.68
Rate for Payer: Wellcare Medicare	$816.68

HC FNA BIOPSY W/US GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10006
Hospital Charge Code	3611000601
Hospital Revenue Code	361
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$461.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50

HC FNA BIOPSY W/US GDN ADD'L LESION

Facility

$923.00

Service Code	CPT 10006
Hospital Charge Code	3611000601
Hospital Revenue Code	361
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.17
Rate for Payer: Aetna Government	$42.17
Rate for Payer: Brighton Health Commercial	$692.25
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	$461.50
Rate for Payer: Group Health Inc Commercial	$461.50
Rate for Payer: Group Health Inc Medicare	$323.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$461.50
Rate for Payer: Hamaspik Choice Inc Medicare	$461.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55.38
Rate for Payer: United Healthcare Commercial	$1,113.00

HC FOLLOW-UP ANGIOGRAPHY - IR ANGIO THRU CATHETER FU 4 EMBOLIZATION

Facility

$4,940.00

Service Code	CPT 75898 TC
Hospital Charge Code	3237589801
Hospital Revenue Code	323
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC FOLLOW-UP ANGIOGRAPHY - IR ANGIO THRU CATHETER FU 4 EMBOLIZATION

Facility

$4,940.00

Service Code	CPT 75898 TC
Hospital Charge Code	3237589801
Hospital Revenue Code	323
Min. Negotiated Rate	$121.41
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$518.96
Rate for Payer: Aetna Government	$518.96
Rate for Payer: Brighton Health Commercial	$3,705.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.66
Rate for Payer: EmblemHealth Commercial	$2,470.00
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00
Rate for Payer: Healthfirst Essential Plan	$273.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$121.41

HC FOOT OR TOE SURGERY - UNLISTED

Facility

$634.00

Service Code	CPT 28899
Hospital Charge Code	3612889901
Hospital Revenue Code	361
Min. Negotiated Rate	$317.00
Max. Negotiated Rate	$317.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$317.00

Know your out-of-pocket cost for care.

All Charges