St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC HTLV/HIV CONFIRMATORY TEST - HIV-1 WESTERN BLOT

Facility

$48.00

Service Code	CPT 86689
Hospital Charge Code	3028668901
Hospital Revenue Code	302
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.00

HC HTLV/HIV CONFIRMATORY TEST - HIV-1 WESTERN BLOT

Facility

$48.00

Service Code	CPT 86689
Hospital Charge Code	3028668901
Hospital Revenue Code	302
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$43.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.35
Rate for Payer: Aetna Government	$19.35
Rate for Payer: Affinity Essential Plan 1&2	$13.54
Rate for Payer: Affinity Essential Plan 3&4	$13.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.54
Rate for Payer: Brighton Health Commercial	$36.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.68
Rate for Payer: Elderplan Medicare Advantage	$19.35
Rate for Payer: EmblemHealth Commercial	$19.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17.41
Rate for Payer: Fidelis Essential Plan Aliesa	$16.45
Rate for Payer: Fidelis Essential Plan QHP	$17.22
Rate for Payer: Fidelis Medicare Advantage	$19.35
Rate for Payer: Fidelis Qualified Health Plan	$17.22
Rate for Payer: Group Health Inc Commercial	$19.35
Rate for Payer: Group Health Inc Medicare	$19.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.35
Rate for Payer: Hamaspik Choice Inc Medicare	$19.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.35
Rate for Payer: Healthfirst Essential Plan	$43.54
Rate for Payer: Healthfirst Medicare Advantage	$19.35
Rate for Payer: Healthfirst QHP	$19.35
Rate for Payer: Humana Medicare	$19.74
Rate for Payer: Senior Whole Health Medicare Advantage	$19.35
Rate for Payer: United Healthcare Commercial	$24.51
Rate for Payer: United Healthcare Medicare Advantage	$19.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.35
Rate for Payer: Wellcare Medicare	$17.41

HC HTLV I - HTLV-I ANTIBODY

Facility

$22.00

Service Code	CPT 86687
Hospital Charge Code	3028668701
Hospital Revenue Code	302
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$20.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.09
Rate for Payer: Aetna Government	$9.09
Rate for Payer: Affinity Essential Plan 1&2	$6.36
Rate for Payer: Affinity Essential Plan 3&4	$6.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.36
Rate for Payer: Brighton Health Commercial	$16.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.02
Rate for Payer: Elderplan Medicare Advantage	$9.09
Rate for Payer: EmblemHealth Commercial	$9.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.18
Rate for Payer: Fidelis Essential Plan Aliesa	$7.73
Rate for Payer: Fidelis Essential Plan QHP	$8.09
Rate for Payer: Fidelis Medicare Advantage	$9.09
Rate for Payer: Fidelis Qualified Health Plan	$8.09
Rate for Payer: Group Health Inc Commercial	$9.09
Rate for Payer: Group Health Inc Medicare	$9.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.09
Rate for Payer: Hamaspik Choice Inc Medicare	$9.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.09
Rate for Payer: Healthfirst Essential Plan	$20.45
Rate for Payer: Healthfirst Medicare Advantage	$9.09
Rate for Payer: Healthfirst QHP	$9.09
Rate for Payer: Humana Medicare	$9.27
Rate for Payer: Senior Whole Health Medicare Advantage	$9.09
Rate for Payer: United Healthcare Commercial	$10.63
Rate for Payer: United Healthcare Medicare Advantage	$9.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.09
Rate for Payer: Wellcare Medicare	$8.18

HC HTLV I - HTLV-I ANTIBODY

Facility

$22.00

Service Code	CPT 86687
Hospital Charge Code	3028668701
Hospital Revenue Code	302
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$11.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.00

HC HTLV-II - HTLV-II ANTIBODY

Facility

$38.00

Service Code	CPT 86688
Hospital Charge Code	3028668801
Hospital Revenue Code	302
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$28.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Affinity Essential Plan 1&2	$9.80
Rate for Payer: Affinity Essential Plan 3&4	$9.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.80
Rate for Payer: Brighton Health Commercial	$28.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.03
Rate for Payer: Elderplan Medicare Advantage	$14.00
Rate for Payer: EmblemHealth Commercial	$14.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.60
Rate for Payer: Fidelis Essential Plan Aliesa	$11.90
Rate for Payer: Fidelis Essential Plan QHP	$12.46
Rate for Payer: Fidelis Medicare Advantage	$14.00
Rate for Payer: Fidelis Qualified Health Plan	$12.46
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$14.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.00
Rate for Payer: Healthfirst Medicare Advantage	$14.00
Rate for Payer: Healthfirst QHP	$14.00
Rate for Payer: Humana Medicare	$14.28
Rate for Payer: Senior Whole Health Medicare Advantage	$14.00
Rate for Payer: United Healthcare Commercial	$17.74
Rate for Payer: United Healthcare Medicare Advantage	$14.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.30
Rate for Payer: Wellcare Medicare	$12.60

HC HTLV-II - HTLV-II ANTIBODY

Facility

$38.00

Service Code	CPT 86688
Hospital Charge Code	3028668801
Hospital Revenue Code	302
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00

HC HT MUSCLE IMAGE PLANAR SING - NM HEART PERFUSION SINGLE

Facility

$3,853.00

Service Code	CPT 78453 TC
Hospital Charge Code	3417845301
Hospital Revenue Code	341
Min. Negotiated Rate	$175.18
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.18
Rate for Payer: Aetna Government	$175.18
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$229.30
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$229.30
Rate for Payer: Healthfirst Essential Plan	$426.06
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$189.36

HC HT MUSCLE IMAGE PLANAR SING - NM HEART PERFUSION SINGLE

Facility

$3,853.00

Service Code	CPT 78453 TC
Hospital Charge Code	3417845301
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT MULT - NM HEART PERFUSION SPECT STRESS & REST

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845201
Hospital Revenue Code	341
Min. Negotiated Rate	$270.74
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$270.74
Rate for Payer: Aetna Government	$270.74
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$365.11
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$365.11
Rate for Payer: Healthfirst Essential Plan	$694.46
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.65

HC HT MUSCLE IMAGE SPECT MULT - NM HEART PERFUSION SPECT STRESS & REST

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845201
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST ADENOSINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845205
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST ADENOSINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845205
Hospital Revenue Code	341
Min. Negotiated Rate	$270.74
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$270.74
Rate for Payer: Aetna Government	$270.74
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$365.11
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$365.11
Rate for Payer: Healthfirst Essential Plan	$694.46
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.65

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST DIPYRIDAMOLE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845203
Hospital Revenue Code	341
Min. Negotiated Rate	$270.74
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$270.74
Rate for Payer: Aetna Government	$270.74
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$365.11
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$365.11
Rate for Payer: Healthfirst Essential Plan	$694.46
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.65

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST DIPYRIDAMOLE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845203
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST DOBUTAMINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845202
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST DOBUTAMINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845202
Hospital Revenue Code	341
Min. Negotiated Rate	$270.74
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$270.74
Rate for Payer: Aetna Government	$270.74
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$365.11
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$365.11
Rate for Payer: Healthfirst Essential Plan	$694.46
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.65

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST EXERCISE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845206
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST EXERCISE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845206
Hospital Revenue Code	341
Min. Negotiated Rate	$270.74
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$270.74
Rate for Payer: Aetna Government	$270.74
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$365.11
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$365.11
Rate for Payer: Healthfirst Essential Plan	$694.46
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.65

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST REGADENOSON W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845204
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT MULT - STRESS TEST REGADENOSON W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78452 TC
Hospital Charge Code	3417845204
Hospital Revenue Code	341
Min. Negotiated Rate	$270.74
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$270.74
Rate for Payer: Aetna Government	$270.74
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$365.11
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$365.11
Rate for Payer: Healthfirst Essential Plan	$694.46
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.65

HC HT MUSCLE IMAGE SPECT SING - NM HEART PERFUSION SPECT REST

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845101
Hospital Revenue Code	341
Min. Negotiated Rate	$188.53
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$188.53
Rate for Payer: Aetna Government	$188.53
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$255.50
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$255.50
Rate for Payer: Healthfirst Essential Plan	$495.18
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$220.08

HC HT MUSCLE IMAGE SPECT SING - NM HEART PERFUSION SPECT REST

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845101
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT SING - STRESS TEST ADENOSINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845105
Hospital Revenue Code	341
Min. Negotiated Rate	$188.53
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$188.53
Rate for Payer: Aetna Government	$188.53
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$255.50
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$255.50
Rate for Payer: Healthfirst Essential Plan	$495.18
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$220.08

HC HT MUSCLE IMAGE SPECT SING - STRESS TEST ADENOSINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845105
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC HT MUSCLE IMAGE SPECT SING - STRESS TEST DIPYRIDAMOLE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845103
Hospital Revenue Code	341
Min. Negotiated Rate	$188.53
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$188.53
Rate for Payer: Aetna Government	$188.53
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,626.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,368.81
Rate for Payer: EmblemHealth Commercial	$255.50
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$255.50
Rate for Payer: Healthfirst Essential Plan	$495.18
Rate for Payer: United Healthcare Commercial	$607.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$220.08

Know your out-of-pocket cost for care.

All Charges