St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC HEMODIALYSIS PROC REQ REPEATED EVAL

Facility

$383.00

Service Code	CPT 90937
Hospital Charge Code	8019093701
Hospital Revenue Code	801
Min. Negotiated Rate	$88.73
Max. Negotiated Rate	$306.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$88.73
Rate for Payer: Aetna Government	$88.73
Rate for Payer: Brighton Health Commercial	$287.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$306.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$260.44
Rate for Payer: EmblemHealth Commercial	$191.50
Rate for Payer: Group Health Inc Commercial	$191.50
Rate for Payer: Group Health Inc Medicare	$134.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.50
Rate for Payer: Hamaspik Choice Inc Medicare	$191.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.78

HC HEMODIALYSIS PROC REQ REPEATED EVAL

Facility

$383.00

Service Code	CPT 90937
Hospital Charge Code	8019093701
Hospital Revenue Code	801
Min. Negotiated Rate	$191.50
Max. Negotiated Rate	$191.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.50

HC HEMODIALYSIS PROC REQ SINGLE EVAL

Facility

$1,891.00

Service Code	CPT 90935
Hospital Charge Code	8019093501
Hospital Revenue Code	801
Min. Negotiated Rate	$76.89
Max. Negotiated Rate	$1,512.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,040.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$854.93
Rate for Payer: Aetna Government	$854.93
Rate for Payer: Affinity Essential Plan 1&2	$598.45
Rate for Payer: Affinity Essential Plan 3&4	$598.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$598.45
Rate for Payer: Brighton Health Commercial	$1,418.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$854.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,512.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,285.88
Rate for Payer: Elderplan Medicare Advantage	$854.93
Rate for Payer: EmblemHealth Commercial	$854.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$769.44
Rate for Payer: Fidelis Essential Plan Aliesa	$726.69
Rate for Payer: Fidelis Essential Plan QHP	$760.89
Rate for Payer: Fidelis Medicare Advantage	$854.93
Rate for Payer: Fidelis Qualified Health Plan	$760.89
Rate for Payer: Group Health Inc Commercial	$854.93
Rate for Payer: Group Health Inc Medicare	$854.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$854.93
Rate for Payer: Hamaspik Choice Inc Medicare	$854.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.89
Rate for Payer: Healthfirst Medicare Advantage	$726.69
Rate for Payer: Healthfirst QHP	$854.93
Rate for Payer: Humana Medicare	$872.03
Rate for Payer: Senior Whole Health Medicare Advantage	$854.93
Rate for Payer: United Healthcare Medicare Advantage	$854.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$854.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$812.18
Rate for Payer: Wellcare Medicare	$812.18

HC HEMODIALYSIS PROC REQ SINGLE EVAL

Facility

$1,891.00

Service Code	CPT 90935
Hospital Charge Code	8019093501
Hospital Revenue Code	801
Min. Negotiated Rate	$945.50
Max. Negotiated Rate	$945.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$945.50

HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBINOPATHY EVAL

Facility

$45.00

Service Code	CPT 83021
Hospital Charge Code	3018302101
Hospital Revenue Code	301
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50

HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBINOPATHY EVAL

Facility

$45.00

Service Code	CPT 83021
Hospital Charge Code	3018302101
Hospital Revenue Code	301
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$40.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.06
Rate for Payer: Aetna Government	$18.06
Rate for Payer: Affinity Essential Plan 1&2	$12.64
Rate for Payer: Affinity Essential Plan 3&4	$12.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.64
Rate for Payer: Brighton Health Commercial	$33.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.83
Rate for Payer: Elderplan Medicare Advantage	$18.06
Rate for Payer: EmblemHealth Commercial	$18.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16.25
Rate for Payer: Fidelis Essential Plan Aliesa	$15.35
Rate for Payer: Fidelis Essential Plan QHP	$16.07
Rate for Payer: Fidelis Medicare Advantage	$18.06
Rate for Payer: Fidelis Qualified Health Plan	$16.07
Rate for Payer: Group Health Inc Commercial	$18.06
Rate for Payer: Group Health Inc Medicare	$18.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.06
Rate for Payer: Hamaspik Choice Inc Medicare	$18.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18.06
Rate for Payer: Healthfirst Essential Plan	$40.63
Rate for Payer: Healthfirst Medicare Advantage	$18.06
Rate for Payer: Healthfirst QHP	$18.06
Rate for Payer: Humana Medicare	$18.42
Rate for Payer: Senior Whole Health Medicare Advantage	$18.06
Rate for Payer: United Healthcare Commercial	$22.87
Rate for Payer: United Healthcare Medicare Advantage	$18.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18.06
Rate for Payer: Wellcare Medicare	$16.25

HC HEMOGLOBIN ELECTROPHORESIS - HEMOGLOBIN ELECTROPHORESIS

Facility

$32.00

Service Code	CPT 83020
Hospital Charge Code	3018302001
Hospital Revenue Code	301
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$28.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.87
Rate for Payer: Aetna Government	$12.87
Rate for Payer: Affinity Essential Plan 1&2	$9.01
Rate for Payer: Affinity Essential Plan 3&4	$9.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.01
Rate for Payer: Brighton Health Commercial	$24.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.43
Rate for Payer: Elderplan Medicare Advantage	$12.87
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.58
Rate for Payer: Fidelis Essential Plan Aliesa	$10.94
Rate for Payer: Fidelis Essential Plan QHP	$11.45
Rate for Payer: Fidelis Medicare Advantage	$12.87
Rate for Payer: Fidelis Qualified Health Plan	$11.45
Rate for Payer: Group Health Inc Commercial	$12.87
Rate for Payer: Group Health Inc Medicare	$12.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.87
Rate for Payer: Hamaspik Choice Inc Medicare	$12.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.87
Rate for Payer: Healthfirst Essential Plan	$28.96
Rate for Payer: Healthfirst Medicare Advantage	$12.87
Rate for Payer: Healthfirst QHP	$12.87
Rate for Payer: Humana Medicare	$13.13
Rate for Payer: Senior Whole Health Medicare Advantage	$12.87
Rate for Payer: United Healthcare Commercial	$16.31
Rate for Payer: United Healthcare Medicare Advantage	$12.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.87
Rate for Payer: Wellcare Medicare	$11.58

HC HEMOGLOBIN ELECTROPHORESIS - HEMOGLOBIN ELECTROPHORESIS

Facility

$32.00

Service Code	CPT 83020
Hospital Charge Code	3018302001
Hospital Revenue Code	301
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00

HC HEMOGLOBIN FETAL,DIFF LYSIS - KLEIHAUER-BETKE STAIN

Facility

$19.00

Service Code	CPT 85460
Hospital Charge Code	3058546001
Hospital Revenue Code	305
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$17.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Affinity Essential Plan 1&2	$5.41
Rate for Payer: Affinity Essential Plan 3&4	$5.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.41
Rate for Payer: Brighton Health Commercial	$14.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.08
Rate for Payer: Elderplan Medicare Advantage	$7.73
Rate for Payer: EmblemHealth Commercial	$7.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.96
Rate for Payer: Fidelis Essential Plan Aliesa	$6.57
Rate for Payer: Fidelis Essential Plan QHP	$6.88
Rate for Payer: Fidelis Medicare Advantage	$7.73
Rate for Payer: Fidelis Qualified Health Plan	$6.88
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$7.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.73
Rate for Payer: Healthfirst Essential Plan	$17.39
Rate for Payer: Healthfirst Medicare Advantage	$7.73
Rate for Payer: Healthfirst QHP	$7.73
Rate for Payer: Humana Medicare	$7.88
Rate for Payer: Senior Whole Health Medicare Advantage	$7.73
Rate for Payer: United Healthcare Commercial	$9.80
Rate for Payer: United Healthcare Medicare Advantage	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.73
Rate for Payer: Wellcare Medicare	$6.96

HC HEMOGLOBIN FETAL,DIFF LYSIS - KLEIHAUER-BETKE STAIN

Facility

$19.00

Service Code	CPT 85460
Hospital Charge Code	3058546001
Hospital Revenue Code	305
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.50

HC HEMOGLOBIN FETAL,ROSETTE - FETAL BLEED SCREEN

Facility

$21.00

Service Code	CPT 85461
Hospital Charge Code	3058546101
Hospital Revenue Code	305
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.50

HC HEMOGLOBIN FETAL,ROSETTE - FETAL BLEED SCREEN

Facility

$21.00

Service Code	CPT 85461
Hospital Charge Code	3058546101
Hospital Revenue Code	305
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$21.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.36
Rate for Payer: Aetna Government	$9.36
Rate for Payer: Affinity Essential Plan 1&2	$6.55
Rate for Payer: Affinity Essential Plan 3&4	$6.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.55
Rate for Payer: Brighton Health Commercial	$15.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.49
Rate for Payer: Elderplan Medicare Advantage	$9.36
Rate for Payer: EmblemHealth Commercial	$9.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.42
Rate for Payer: Fidelis Essential Plan Aliesa	$7.96
Rate for Payer: Fidelis Essential Plan QHP	$8.33
Rate for Payer: Fidelis Medicare Advantage	$9.36
Rate for Payer: Fidelis Qualified Health Plan	$8.33
Rate for Payer: Group Health Inc Commercial	$9.36
Rate for Payer: Group Health Inc Medicare	$9.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.36
Rate for Payer: Hamaspik Choice Inc Medicare	$9.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.36
Rate for Payer: Healthfirst Essential Plan	$21.06
Rate for Payer: Healthfirst Medicare Advantage	$9.36
Rate for Payer: Healthfirst QHP	$9.36
Rate for Payer: Humana Medicare	$9.55
Rate for Payer: Senior Whole Health Medicare Advantage	$9.36
Rate for Payer: United Healthcare Commercial	$8.41
Rate for Payer: United Healthcare Medicare Advantage	$9.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.36
Rate for Payer: Wellcare Medicare	$8.42

HC HEMOGLOBIN, F FETAL, QUALITATIVE

Facility

$20.00

Service Code	CPT 83033
Hospital Charge Code	3018303301
Hospital Revenue Code	301
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$15.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Affinity Essential Plan 1&2	$5.60
Rate for Payer: Affinity Essential Plan 3&4	$5.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.60
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.53
Rate for Payer: Elderplan Medicare Advantage	$8.00
Rate for Payer: EmblemHealth Commercial	$8.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.20
Rate for Payer: Fidelis Essential Plan Aliesa	$6.80
Rate for Payer: Fidelis Essential Plan QHP	$7.12
Rate for Payer: Fidelis Medicare Advantage	$8.00
Rate for Payer: Fidelis Qualified Health Plan	$7.12
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.00
Rate for Payer: Healthfirst Medicare Advantage	$8.00
Rate for Payer: Healthfirst QHP	$8.00
Rate for Payer: Humana Medicare	$8.16
Rate for Payer: Senior Whole Health Medicare Advantage	$8.00
Rate for Payer: United Healthcare Commercial	$7.55
Rate for Payer: United Healthcare Medicare Advantage	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.60
Rate for Payer: Wellcare Medicare	$7.20

HC HEMOGLOBIN, F FETAL, QUALITATIVE

Facility

$20.00

Service Code	CPT 83033
Hospital Charge Code	3018303301
Hospital Revenue Code	301
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00

HC HEMOGLOBIN - HEMOGLOBIN

Facility

$5.00

Service Code	CPT 85018
Hospital Charge Code	3058501801
Hospital Revenue Code	305
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$4.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.37
Rate for Payer: Aetna Government	$2.37
Rate for Payer: Affinity Essential Plan 1&2	$1.66
Rate for Payer: Affinity Essential Plan 3&4	$1.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.66
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: Elderplan Medicare Advantage	$2.37
Rate for Payer: EmblemHealth Commercial	$2.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.13
Rate for Payer: Fidelis Essential Plan Aliesa	$2.01
Rate for Payer: Fidelis Essential Plan QHP	$2.11
Rate for Payer: Fidelis Medicare Advantage	$2.37
Rate for Payer: Fidelis Qualified Health Plan	$2.11
Rate for Payer: Group Health Inc Commercial	$2.37
Rate for Payer: Group Health Inc Medicare	$2.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.37
Rate for Payer: Hamaspik Choice Inc Medicare	$2.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.02
Rate for Payer: Healthfirst Essential Plan	$4.54
Rate for Payer: Healthfirst Medicare Advantage	$2.37
Rate for Payer: Healthfirst QHP	$2.37
Rate for Payer: Humana Medicare	$2.42
Rate for Payer: Senior Whole Health Medicare Advantage	$2.37
Rate for Payer: United Healthcare Commercial	$3.00
Rate for Payer: United Healthcare Medicare Advantage	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.02
Rate for Payer: Wellcare Medicare	$2.13

HC HEMOGLOBIN - HEMOGLOBIN

Facility

$5.00

Service Code	CPT 85018
Hospital Charge Code	3058501801
Hospital Revenue Code	305
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50

HC HEMOGLOBIN - HEMOGLOBIN AND HEMATOCRIT

Facility

$5.00

Service Code	CPT 85018
Hospital Charge Code	3058501802
Hospital Revenue Code	305
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50

HC HEMOGLOBIN - HEMOGLOBIN AND HEMATOCRIT

Facility

$5.00

Service Code	CPT 85018
Hospital Charge Code	3058501802
Hospital Revenue Code	305
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$4.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.37
Rate for Payer: Aetna Government	$2.37
Rate for Payer: Affinity Essential Plan 1&2	$1.66
Rate for Payer: Affinity Essential Plan 3&4	$1.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.66
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: Elderplan Medicare Advantage	$2.37
Rate for Payer: EmblemHealth Commercial	$2.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.13
Rate for Payer: Fidelis Essential Plan Aliesa	$2.01
Rate for Payer: Fidelis Essential Plan QHP	$2.11
Rate for Payer: Fidelis Medicare Advantage	$2.37
Rate for Payer: Fidelis Qualified Health Plan	$2.11
Rate for Payer: Group Health Inc Commercial	$2.37
Rate for Payer: Group Health Inc Medicare	$2.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.37
Rate for Payer: Hamaspik Choice Inc Medicare	$2.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.02
Rate for Payer: Healthfirst Essential Plan	$4.54
Rate for Payer: Healthfirst Medicare Advantage	$2.37
Rate for Payer: Healthfirst QHP	$2.37
Rate for Payer: Humana Medicare	$2.42
Rate for Payer: Senior Whole Health Medicare Advantage	$2.37
Rate for Payer: United Healthcare Commercial	$3.00
Rate for Payer: United Healthcare Medicare Advantage	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.02
Rate for Payer: Wellcare Medicare	$2.13

HC HEMOGLOBIN, METHEMOGLOBIN, QUALITATIVE

Facility

$16.00

Service Code	CPT 83045
Hospital Charge Code	3018304501
Hospital Revenue Code	301
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00

HC HEMOGLOBIN, METHEMOGLOBIN, QUALITATIVE

Facility

$16.00

Service Code	CPT 83045
Hospital Charge Code	3018304501
Hospital Revenue Code	301
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$12.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.49
Rate for Payer: Aetna Government	$6.49
Rate for Payer: Affinity Essential Plan 1&2	$4.54
Rate for Payer: Affinity Essential Plan 3&4	$4.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.54
Rate for Payer: Brighton Health Commercial	$12.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.09
Rate for Payer: Elderplan Medicare Advantage	$6.49
Rate for Payer: EmblemHealth Commercial	$6.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.84
Rate for Payer: Fidelis Essential Plan Aliesa	$5.52
Rate for Payer: Fidelis Essential Plan QHP	$5.78
Rate for Payer: Fidelis Medicare Advantage	$6.49
Rate for Payer: Fidelis Qualified Health Plan	$5.78
Rate for Payer: Group Health Inc Commercial	$6.49
Rate for Payer: Group Health Inc Medicare	$6.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.49
Rate for Payer: Hamaspik Choice Inc Medicare	$6.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.49
Rate for Payer: Healthfirst Medicare Advantage	$6.49
Rate for Payer: Healthfirst QHP	$6.49
Rate for Payer: Humana Medicare	$6.62
Rate for Payer: Senior Whole Health Medicare Advantage	$6.49
Rate for Payer: United Healthcare Commercial	$6.27
Rate for Payer: United Healthcare Medicare Advantage	$6.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.17
Rate for Payer: Wellcare Medicare	$5.84

HC HEMOGLOBIN - POCT HEMOGLOBIN

Facility

$5.00

Service Code	CPT 85018
Hospital Charge Code	3058501803
Hospital Revenue Code	305
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$4.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.37
Rate for Payer: Aetna Government	$2.37
Rate for Payer: Affinity Essential Plan 1&2	$1.66
Rate for Payer: Affinity Essential Plan 3&4	$1.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.66
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.38
Rate for Payer: Elderplan Medicare Advantage	$2.37
Rate for Payer: EmblemHealth Commercial	$2.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.13
Rate for Payer: Fidelis Essential Plan Aliesa	$2.01
Rate for Payer: Fidelis Essential Plan QHP	$2.11
Rate for Payer: Fidelis Medicare Advantage	$2.37
Rate for Payer: Fidelis Qualified Health Plan	$2.11
Rate for Payer: Group Health Inc Commercial	$2.37
Rate for Payer: Group Health Inc Medicare	$2.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.37
Rate for Payer: Hamaspik Choice Inc Medicare	$2.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.02
Rate for Payer: Healthfirst Essential Plan	$4.54
Rate for Payer: Healthfirst Medicare Advantage	$2.37
Rate for Payer: Healthfirst QHP	$2.37
Rate for Payer: Humana Medicare	$2.42
Rate for Payer: Senior Whole Health Medicare Advantage	$2.37
Rate for Payer: United Healthcare Commercial	$3.00
Rate for Payer: United Healthcare Medicare Advantage	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.02
Rate for Payer: Wellcare Medicare	$2.13

HC HEMOGLOBIN - POCT HEMOGLOBIN

Facility

$5.00

Service Code	CPT 85018
Hospital Charge Code	3058501803
Hospital Revenue Code	305
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50

HC HEMOLYSINS & AGGLUTININS, INCUBATED

Facility

$30.00

Service Code	CPT 86941
Hospital Charge Code	3008694101
Hospital Revenue Code	300
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$23.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.11
Rate for Payer: Aetna Government	$12.11
Rate for Payer: Affinity Essential Plan 1&2	$8.48
Rate for Payer: Affinity Essential Plan 3&4	$8.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.48
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.34
Rate for Payer: Elderplan Medicare Advantage	$12.11
Rate for Payer: EmblemHealth Commercial	$12.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.90
Rate for Payer: Fidelis Essential Plan Aliesa	$10.29
Rate for Payer: Fidelis Essential Plan QHP	$10.78
Rate for Payer: Fidelis Medicare Advantage	$12.11
Rate for Payer: Fidelis Qualified Health Plan	$10.78
Rate for Payer: Group Health Inc Commercial	$12.11
Rate for Payer: Group Health Inc Medicare	$12.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.11
Rate for Payer: Hamaspik Choice Inc Medicare	$12.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.37
Rate for Payer: Healthfirst Essential Plan	$23.33
Rate for Payer: Healthfirst Medicare Advantage	$12.11
Rate for Payer: Healthfirst QHP	$12.11
Rate for Payer: Humana Medicare	$12.35
Rate for Payer: Senior Whole Health Medicare Advantage	$12.11
Rate for Payer: United Healthcare Commercial	$15.34
Rate for Payer: United Healthcare Medicare Advantage	$12.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.37
Rate for Payer: Wellcare Medicare	$10.90

HC HEMOLYSINS & AGGLUTININS, INCUBATED

Facility

$30.00

Service Code	CPT 86941
Hospital Charge Code	3008694101
Hospital Revenue Code	300
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00

HC HEMRRHOIDECTOMY, INTERNAL

Facility

$2,313.00

Service Code	CPT 46221
Hospital Charge Code	5104622101
Hospital Revenue Code	510
Min. Negotiated Rate	$1,156.50
Max. Negotiated Rate	$1,156.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,156.50

Know your out-of-pocket cost for care.

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