St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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 DOBUTAMINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845102
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 DOBUTAMINE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845102
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 EXERCISE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845106
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 EXERCISE W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845106
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 REGADENOSON W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845104
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 REGADENOSON W MYOCARD PERF

Facility

$3,853.00

Service Code	CPT 78451 TC
Hospital Charge Code	3417845104
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 HUMAN GRANULOCYTIC EHRLICH-HGE

Facility

$25.00

Service Code	CPT 86666
Hospital Charge Code	3028666602
Hospital Revenue Code	302
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$18.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.18
Rate for Payer: Aetna Government	$10.18
Rate for Payer: Affinity Essential Plan 1&2	$7.13
Rate for Payer: Affinity Essential Plan 3&4	$7.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.13
Rate for Payer: Brighton Health Commercial	$18.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.55
Rate for Payer: Elderplan Medicare Advantage	$10.18
Rate for Payer: EmblemHealth Commercial	$10.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9.16
Rate for Payer: Fidelis Essential Plan Aliesa	$8.65
Rate for Payer: Fidelis Essential Plan QHP	$9.06
Rate for Payer: Fidelis Medicare Advantage	$10.18
Rate for Payer: Fidelis Qualified Health Plan	$9.06
Rate for Payer: Group Health Inc Commercial	$10.18
Rate for Payer: Group Health Inc Medicare	$10.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.18
Rate for Payer: Hamaspik Choice Inc Medicare	$10.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.11
Rate for Payer: Healthfirst Essential Plan	$18.25
Rate for Payer: Healthfirst Medicare Advantage	$10.18
Rate for Payer: Healthfirst QHP	$10.18
Rate for Payer: Humana Medicare	$10.38
Rate for Payer: Senior Whole Health Medicare Advantage	$10.18
Rate for Payer: United Healthcare Commercial	$12.89
Rate for Payer: United Healthcare Medicare Advantage	$10.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.11
Rate for Payer: Wellcare Medicare	$9.16

HC HUMAN GRANULOCYTIC EHRLICH-HGE

Facility

$25.00

Service Code	CPT 86666
Hospital Charge Code	3028666602
Hospital Revenue Code	302
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50

HC HYALOMATRIX, PER SQ CM

Facility

$42.00

Service Code	CPT Q4117
Hospital Charge Code	636Q411701
Hospital Revenue Code	636
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00

HC HYALOMATRIX, PER SQ CM

Facility

$42.00

Service Code	CPT Q4117
Hospital Charge Code	636Q411701
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$27.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.80
Rate for Payer: Aetna Government	$19.80
Rate for Payer: Brighton Health Commercial	$25.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.15
Rate for Payer: EmblemHealth Commercial	$21.00
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.30

HC HYPERBARIC OXYGEN THERAPY 30 MIN

Facility

$1,394.00

Service Code	CPT G0277
Hospital Charge Code	940G027701
Hospital Revenue Code	940
Min. Negotiated Rate	$697.00
Max. Negotiated Rate	$697.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$697.00

HC HYPERBARIC OXYGEN THERAPY 30 MIN

Facility

$1,394.00

Service Code	CPT G0277
Hospital Charge Code	940G027701
Hospital Revenue Code	940
Min. Negotiated Rate	$117.94
Max. Negotiated Rate	$1,115.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$766.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$168.49
Rate for Payer: Aetna Government	$168.49
Rate for Payer: Affinity Essential Plan 1&2	$117.94
Rate for Payer: Affinity Essential Plan 3&4	$117.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$117.94
Rate for Payer: Brighton Health Commercial	$1,045.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$168.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,115.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$947.92
Rate for Payer: Elderplan Medicare Advantage	$168.49
Rate for Payer: EmblemHealth Commercial	$168.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$151.64
Rate for Payer: Fidelis Essential Plan Aliesa	$143.22
Rate for Payer: Fidelis Essential Plan QHP	$149.96
Rate for Payer: Fidelis Medicare Advantage	$168.49
Rate for Payer: Fidelis Qualified Health Plan	$149.96
Rate for Payer: Group Health Inc Commercial	$168.49
Rate for Payer: Group Health Inc Medicare	$168.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.49
Rate for Payer: Hamaspik Choice Inc Medicare	$168.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$205.09
Rate for Payer: Healthfirst Medicare Advantage	$143.22
Rate for Payer: Healthfirst QHP	$168.49
Rate for Payer: Humana Medicare	$171.86
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$176.91
Rate for Payer: Senior Whole Health Medicare Advantage	$168.49
Rate for Payer: United Healthcare Commercial	$697.00
Rate for Payer: United Healthcare Medicare Advantage	$168.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$160.07
Rate for Payer: Wellcare Medicare	$160.07

HC HYSTEROSALPINGOGRAPHY

Facility

$371.00

Service Code	CPT 58340
Hospital Charge Code	3615834001
Hospital Revenue Code	361
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.50

HC HYSTEROSALPINGOGRAPHY

Facility

$371.00

Service Code	CPT 58340
Hospital Charge Code	3615834001
Hospital Revenue Code	361
Min. Negotiated Rate	$67.53
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.24
Rate for Payer: Aetna Government	$72.24
Rate for Payer: Brighton Health Commercial	$278.25
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	$185.50
Rate for Payer: Group Health Inc Commercial	$185.50
Rate for Payer: Group Health Inc Medicare	$129.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.50
Rate for Payer: Hamaspik Choice Inc Medicare	$185.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67.53
Rate for Payer: United Healthcare Commercial	$1,113.00

HC HYSTEROSCOPY,DX,SEP PROC

Facility

$8,480.00

Service Code	CPT 58555
Hospital Charge Code	3615855501
Hospital Revenue Code	361
Min. Negotiated Rate	$176.63
Max. Negotiated Rate	$6,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,884.81
Rate for Payer: Aetna Government	$3,884.81
Rate for Payer: Affinity Essential Plan 1&2	$2,719.37
Rate for Payer: Affinity Essential Plan 3&4	$2,719.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,719.37
Rate for Payer: Brighton Health Commercial	$6,360.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,884.81
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	$3,884.81
Rate for Payer: EmblemHealth Commercial	$3,884.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,496.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,302.09
Rate for Payer: Fidelis Essential Plan QHP	$3,457.48
Rate for Payer: Fidelis Medicare Advantage	$3,884.81
Rate for Payer: Fidelis Qualified Health Plan	$3,457.48
Rate for Payer: Group Health Inc Commercial	$3,884.81
Rate for Payer: Group Health Inc Medicare	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicare	$1,674.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$176.63
Rate for Payer: Healthfirst Medicare Advantage	$3,302.09
Rate for Payer: Healthfirst QHP	$3,884.81
Rate for Payer: Humana Medicare	$3,962.51
Rate for Payer: Senior Whole Health Medicare Advantage	$3,884.81
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,884.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,884.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,690.57
Rate for Payer: Wellcare Medicare	$3,690.57

HC HYSTEROSCOPY,DX,SEP PROC

Facility

$8,480.00

Service Code	CPT 58555
Hospital Charge Code	3615855501
Hospital Revenue Code	361
Min. Negotiated Rate	$4,240.00
Max. Negotiated Rate	$4,240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,240.00

HC HYSTEROSCOPY,LYSIS ADHESIONS

Facility

$13,901.00

Service Code	CPT 58559
Hospital Charge Code	3615855901
Hospital Revenue Code	361
Min. Negotiated Rate	$326.85
Max. Negotiated Rate	$10,425.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,031.45
Rate for Payer: Aetna Government	$6,031.45
Rate for Payer: Affinity Essential Plan 1&2	$4,222.02
Rate for Payer: Affinity Essential Plan 3&4	$4,222.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,222.02
Rate for Payer: Brighton Health Commercial	$10,425.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,031.45
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	$6,031.45
Rate for Payer: EmblemHealth Commercial	$6,031.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5,428.31
Rate for Payer: Fidelis Essential Plan Aliesa	$5,126.73
Rate for Payer: Fidelis Essential Plan QHP	$5,367.99
Rate for Payer: Fidelis Medicare Advantage	$6,031.45
Rate for Payer: Fidelis Qualified Health Plan	$5,367.99
Rate for Payer: Group Health Inc Commercial	$6,031.45
Rate for Payer: Group Health Inc Medicare	$6,031.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,031.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,225.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$326.85
Rate for Payer: Healthfirst Medicare Advantage	$5,126.73
Rate for Payer: Healthfirst QHP	$6,031.45
Rate for Payer: Humana Medicare	$6,152.08
Rate for Payer: Senior Whole Health Medicare Advantage	$6,031.45
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$6,031.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,031.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,729.88
Rate for Payer: Wellcare Medicare	$5,729.88

HC HYSTEROSCOPY,LYSIS ADHESIONS

Facility

$13,901.00

Service Code	CPT 58559
Hospital Charge Code	3615855901
Hospital Revenue Code	361
Min. Negotiated Rate	$6,950.50
Max. Negotiated Rate	$6,950.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,950.50

HC HYSTEROSCOPY,RESECT SEPTUM

Facility

$13,901.00

Service Code	CPT 58560
Hospital Charge Code	3615856001
Hospital Revenue Code	361
Min. Negotiated Rate	$6,950.50
Max. Negotiated Rate	$6,950.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,950.50

HC HYSTEROSCOPY,RESECT SEPTUM

Facility

$13,901.00

Service Code	CPT 58560
Hospital Charge Code	3615856001
Hospital Revenue Code	361
Min. Negotiated Rate	$360.13
Max. Negotiated Rate	$10,425.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,031.45
Rate for Payer: Aetna Government	$6,031.45
Rate for Payer: Affinity Essential Plan 1&2	$4,222.02
Rate for Payer: Affinity Essential Plan 3&4	$4,222.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,222.02
Rate for Payer: Brighton Health Commercial	$10,425.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,031.45
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	$6,031.45
Rate for Payer: EmblemHealth Commercial	$6,031.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5,428.31
Rate for Payer: Fidelis Essential Plan Aliesa	$5,126.73
Rate for Payer: Fidelis Essential Plan QHP	$5,367.99
Rate for Payer: Fidelis Medicare Advantage	$6,031.45
Rate for Payer: Fidelis Qualified Health Plan	$5,367.99
Rate for Payer: Group Health Inc Commercial	$6,031.45
Rate for Payer: Group Health Inc Medicare	$6,031.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,031.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,225.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$360.13
Rate for Payer: Healthfirst Medicare Advantage	$5,126.73
Rate for Payer: Healthfirst QHP	$6,031.45
Rate for Payer: Humana Medicare	$6,152.08
Rate for Payer: Senior Whole Health Medicare Advantage	$6,031.45
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$6,031.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,031.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,729.88
Rate for Payer: Wellcare Medicare	$5,729.88

HC HYSTEROSCOPY,RMV FB

Facility

$8,480.00

Service Code	CPT 58562
Hospital Charge Code	3615856201
Hospital Revenue Code	361
Min. Negotiated Rate	$255.06
Max. Negotiated Rate	$6,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,884.81
Rate for Payer: Aetna Government	$3,884.81
Rate for Payer: Affinity Essential Plan 1&2	$2,719.37
Rate for Payer: Affinity Essential Plan 3&4	$2,719.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,719.37
Rate for Payer: Brighton Health Commercial	$6,360.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,884.81
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	$3,884.81
Rate for Payer: EmblemHealth Commercial	$3,884.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,496.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,302.09
Rate for Payer: Fidelis Essential Plan QHP	$3,457.48
Rate for Payer: Fidelis Medicare Advantage	$3,884.81
Rate for Payer: Fidelis Qualified Health Plan	$3,457.48
Rate for Payer: Group Health Inc Commercial	$3,884.81
Rate for Payer: Group Health Inc Medicare	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicare	$1,674.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$255.06
Rate for Payer: Healthfirst Medicare Advantage	$3,302.09
Rate for Payer: Healthfirst QHP	$3,884.81
Rate for Payer: Humana Medicare	$3,962.51
Rate for Payer: Senior Whole Health Medicare Advantage	$3,884.81
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,884.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,884.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,690.57
Rate for Payer: Wellcare Medicare	$3,690.57

HC HYSTEROSCOPY,RMV FB

Facility

$8,480.00

Service Code	CPT 58562
Hospital Charge Code	3615856201
Hospital Revenue Code	361
Min. Negotiated Rate	$4,240.00
Max. Negotiated Rate	$4,240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,240.00

HC HYSTEROSCOPY,RMV MYOMA

Facility

$13,901.00

Service Code	CPT 58561
Hospital Charge Code	3615856101
Hospital Revenue Code	361
Min. Negotiated Rate	$412.04
Max. Negotiated Rate	$10,425.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,031.45
Rate for Payer: Aetna Government	$6,031.45
Rate for Payer: Affinity Essential Plan 1&2	$4,222.02
Rate for Payer: Affinity Essential Plan 3&4	$4,222.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,222.02
Rate for Payer: Brighton Health Commercial	$10,425.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,031.45
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	$6,031.45
Rate for Payer: EmblemHealth Commercial	$6,031.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5,428.31
Rate for Payer: Fidelis Essential Plan Aliesa	$5,126.73
Rate for Payer: Fidelis Essential Plan QHP	$5,367.99
Rate for Payer: Fidelis Medicare Advantage	$6,031.45
Rate for Payer: Fidelis Qualified Health Plan	$5,367.99
Rate for Payer: Group Health Inc Commercial	$6,031.45
Rate for Payer: Group Health Inc Medicare	$6,031.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,031.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,225.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$412.04
Rate for Payer: Healthfirst Medicare Advantage	$5,126.73
Rate for Payer: Healthfirst QHP	$6,031.45
Rate for Payer: Humana Medicare	$6,152.08
Rate for Payer: Senior Whole Health Medicare Advantage	$6,031.45
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$6,031.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,031.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,729.88
Rate for Payer: Wellcare Medicare	$5,729.88

HC HYSTEROSCOPY,RMV MYOMA

Facility

$13,901.00

Service Code	CPT 58561
Hospital Charge Code	3615856101
Hospital Revenue Code	361
Min. Negotiated Rate	$6,950.50
Max. Negotiated Rate	$6,950.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,950.50

Know your out-of-pocket cost for care.

All Charges