St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/O GUIDANCE

Facility

$2,459.00

Service Code	CPT 62326
Hospital Charge Code	5106232601
Hospital Revenue Code	510
Min. Negotiated Rate	$1,229.50
Max. Negotiated Rate	$1,229.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.50

HC INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/O GUIDANCE

Facility

$2,459.00

Service Code	CPT 62326
Hospital Charge Code	5106232601
Hospital Revenue Code	510
Min. Negotiated Rate	$94.89
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,087.77
Rate for Payer: Aetna Government	$1,087.77
Rate for Payer: Affinity Essential Plan 1&2	$761.44
Rate for Payer: Affinity Essential Plan 3&4	$761.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$761.44
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,087.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$1,087.77
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$978.99
Rate for Payer: Fidelis Essential Plan Aliesa	$924.60
Rate for Payer: Fidelis Essential Plan QHP	$968.12
Rate for Payer: Fidelis Medicare Advantage	$1,087.77
Rate for Payer: Fidelis Qualified Health Plan	$968.12
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,087.77
Rate for Payer: Hamaspik Choice Inc Medicare	$477.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$94.89
Rate for Payer: Healthfirst Medicare Advantage	$924.60
Rate for Payer: Healthfirst QHP	$1,087.77
Rate for Payer: Humana Medicare	$1,109.53
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,142.16
Rate for Payer: Senior Whole Health Medicare Advantage	$1,087.77
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,087.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,087.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,033.38
Rate for Payer: Wellcare Medicare	$1,033.38

HC INJX INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/GUIDANCE

Facility

$1,893.00

Service Code	CPT 62321 TC
Hospital Charge Code	3616232101
Hospital Revenue Code	361
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$946.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50

HC INJX INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/GUIDANCE

Facility

$1,893.00

Service Code	CPT 62321 TC
Hospital Charge Code	3616232101
Hospital Revenue Code	361
Min. Negotiated Rate	$287.50
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$287.50
Rate for Payer: Aetna Government	$287.50
Rate for Payer: Brighton Health Commercial	$1,419.75
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	$946.50
Rate for Payer: Group Health Inc Commercial	$946.50
Rate for Payer: Group Health Inc Medicare	$662.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50
Rate for Payer: Hamaspik Choice Inc Medicare	$371.75
Rate for Payer: United Healthcare Commercial	$1,188.00

HC INJX INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/O GUIDANCE

Facility

$1,893.00

Service Code	CPT 62320
Hospital Charge Code	3616232001
Hospital Revenue Code	361
Min. Negotiated Rate	$112.78
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$846.13
Rate for Payer: Aetna Government	$846.13
Rate for Payer: Affinity Essential Plan 1&2	$592.29
Rate for Payer: Affinity Essential Plan 3&4	$592.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$592.29
Rate for Payer: Brighton Health Commercial	$1,419.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$846.13
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	$846.13
Rate for Payer: EmblemHealth Commercial	$846.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$761.52
Rate for Payer: Fidelis Essential Plan Aliesa	$719.21
Rate for Payer: Fidelis Essential Plan QHP	$753.06
Rate for Payer: Fidelis Medicare Advantage	$846.13
Rate for Payer: Fidelis Qualified Health Plan	$753.06
Rate for Payer: Group Health Inc Commercial	$846.13
Rate for Payer: Group Health Inc Medicare	$846.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$846.13
Rate for Payer: Hamaspik Choice Inc Medicare	$371.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$112.78
Rate for Payer: Healthfirst Medicare Advantage	$719.21
Rate for Payer: Healthfirst QHP	$846.13
Rate for Payer: Humana Medicare	$863.05
Rate for Payer: Senior Whole Health Medicare Advantage	$846.13
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$846.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$846.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$803.82
Rate for Payer: Wellcare Medicare	$803.82

HC INJX INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/O GUIDANCE

Facility

$1,893.00

Service Code	CPT 62320
Hospital Charge Code	3616232001
Hospital Revenue Code	361
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$946.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50

HC INJX INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/GUIDANCE

Facility

$1,893.00

Service Code	CPT 62323 TC
Hospital Charge Code	3616232301
Hospital Revenue Code	361
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$946.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50

HC INJX INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/GUIDANCE

Facility

$1,893.00

Service Code	CPT 62323 TC
Hospital Charge Code	3616232301
Hospital Revenue Code	361
Min. Negotiated Rate	$282.05
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$282.05
Rate for Payer: Aetna Government	$282.05
Rate for Payer: Brighton Health Commercial	$1,419.75
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	$946.50
Rate for Payer: Group Health Inc Commercial	$946.50
Rate for Payer: Group Health Inc Medicare	$662.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50
Rate for Payer: Hamaspik Choice Inc Medicare	$371.75
Rate for Payer: United Healthcare Commercial	$1,188.00

HC INJX INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/O GUIDANCE

Facility

$1,893.00

Service Code	CPT 62322
Hospital Charge Code	3616232201
Hospital Revenue Code	361
Min. Negotiated Rate	$87.74
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,087.77
Rate for Payer: Aetna Government	$1,087.77
Rate for Payer: Affinity Essential Plan 1&2	$761.44
Rate for Payer: Affinity Essential Plan 3&4	$761.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$761.44
Rate for Payer: Brighton Health Commercial	$1,419.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,087.77
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	$1,087.77
Rate for Payer: EmblemHealth Commercial	$1,087.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$978.99
Rate for Payer: Fidelis Essential Plan Aliesa	$924.60
Rate for Payer: Fidelis Essential Plan QHP	$968.12
Rate for Payer: Fidelis Medicare Advantage	$1,087.77
Rate for Payer: Fidelis Qualified Health Plan	$968.12
Rate for Payer: Group Health Inc Commercial	$1,087.77
Rate for Payer: Group Health Inc Medicare	$1,087.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,087.77
Rate for Payer: Hamaspik Choice Inc Medicare	$477.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$87.74
Rate for Payer: Healthfirst Medicare Advantage	$924.60
Rate for Payer: Healthfirst QHP	$1,087.77
Rate for Payer: Humana Medicare	$1,109.53
Rate for Payer: Senior Whole Health Medicare Advantage	$1,087.77
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$1,087.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,087.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,033.38
Rate for Payer: Wellcare Medicare	$1,033.38

HC INJX INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/O GUIDANCE

Facility

$1,893.00

Service Code	CPT 62322
Hospital Charge Code	3616232201
Hospital Revenue Code	361
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$946.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50

HC INJX, INTRALESIONAL, <=7 LESIONS

Facility

$529.00

Service Code	CPT 11900
Hospital Charge Code	3611190001
Hospital Revenue Code	361
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

HC INJX, INTRALESIONAL, <=7 LESIONS

Facility

$529.00

Service Code	CPT 11900
Hospital Charge Code	3611190001
Hospital Revenue Code	361
Min. Negotiated Rate	$33.04
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.78
Rate for Payer: Aetna Government	$242.78
Rate for Payer: Affinity Essential Plan 1&2	$169.95
Rate for Payer: Affinity Essential Plan 3&4	$169.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.95
Rate for Payer: Brighton Health Commercial	$396.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$242.78
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	$242.78
Rate for Payer: EmblemHealth Commercial	$242.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$218.50
Rate for Payer: Fidelis Essential Plan Aliesa	$206.36
Rate for Payer: Fidelis Essential Plan QHP	$216.07
Rate for Payer: Fidelis Medicare Advantage	$242.78
Rate for Payer: Fidelis Qualified Health Plan	$216.07
Rate for Payer: Group Health Inc Commercial	$242.78
Rate for Payer: Group Health Inc Medicare	$242.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.78
Rate for Payer: Hamaspik Choice Inc Medicare	$242.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33.04
Rate for Payer: Healthfirst Medicare Advantage	$206.36
Rate for Payer: Healthfirst QHP	$242.78
Rate for Payer: Humana Medicare	$247.64
Rate for Payer: Senior Whole Health Medicare Advantage	$242.78
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$242.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$242.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$230.64
Rate for Payer: Wellcare Medicare	$230.64

HC INJX, INTRALESIONAL, >7 LESIONS

Facility

$529.00

Service Code	CPT 11901
Hospital Charge Code	3611190101
Hospital Revenue Code	361
Min. Negotiated Rate	$50.52
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.78
Rate for Payer: Aetna Government	$242.78
Rate for Payer: Affinity Essential Plan 1&2	$169.95
Rate for Payer: Affinity Essential Plan 3&4	$169.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.95
Rate for Payer: Brighton Health Commercial	$396.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$242.78
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	$242.78
Rate for Payer: EmblemHealth Commercial	$242.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$218.50
Rate for Payer: Fidelis Essential Plan Aliesa	$206.36
Rate for Payer: Fidelis Essential Plan QHP	$216.07
Rate for Payer: Fidelis Medicare Advantage	$242.78
Rate for Payer: Fidelis Qualified Health Plan	$216.07
Rate for Payer: Group Health Inc Commercial	$242.78
Rate for Payer: Group Health Inc Medicare	$242.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.78
Rate for Payer: Hamaspik Choice Inc Medicare	$242.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.52
Rate for Payer: Healthfirst Medicare Advantage	$206.36
Rate for Payer: Healthfirst QHP	$242.78
Rate for Payer: Humana Medicare	$247.64
Rate for Payer: Senior Whole Health Medicare Advantage	$242.78
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$242.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$242.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$230.64
Rate for Payer: Wellcare Medicare	$230.64

HC INJX, INTRALESIONAL, >7 LESIONS

Facility

$529.00

Service Code	CPT 11901
Hospital Charge Code	3611190101
Hospital Revenue Code	361
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$264.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.50

HC INJX NONCMPND SCLEROSANT W/ US COMPRESSN MULTIPLE VEINS

Facility

$4,914.00

Service Code	CPT 36466 TC
Hospital Charge Code	3613646601
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$3,685.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,818.23
Rate for Payer: Aetna Government	$1,818.23
Rate for Payer: Brighton Health Commercial	$3,685.50
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	$2,457.00
Rate for Payer: Group Health Inc Commercial	$2,457.00
Rate for Payer: Group Health Inc Medicare	$1,719.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,457.00
Rate for Payer: Hamaspik Choice Inc Medicare	$981.09
Rate for Payer: United Healthcare Commercial	$1,409.00

HC INJX NONCMPND SCLEROSANT W/ US COMPRESSN MULTIPLE VEINS

Facility

$4,914.00

Service Code	CPT 36466 TC
Hospital Charge Code	3613646601
Hospital Revenue Code	361
Min. Negotiated Rate	$2,457.00
Max. Negotiated Rate	$2,457.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,457.00

HC INJX NONCMPND SCLEROSANT W/ US COMPRESSN SINGLE VEIN

Facility

$4,914.00

Service Code	CPT 36465 TC
Hospital Charge Code	3613646501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,457.00
Max. Negotiated Rate	$2,457.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,457.00

HC INJX NONCMPND SCLEROSANT W/ US COMPRESSN SINGLE VEIN

Facility

$4,914.00

Service Code	CPT 36465 TC
Hospital Charge Code	3613646501
Hospital Revenue Code	361
Min. Negotiated Rate	$130.74
Max. Negotiated Rate	$3,685.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.74
Rate for Payer: Aetna Government	$130.74
Rate for Payer: Brighton Health Commercial	$3,685.50
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	$2,457.00
Rate for Payer: Group Health Inc Commercial	$2,457.00
Rate for Payer: Group Health Inc Medicare	$1,719.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,457.00
Rate for Payer: Hamaspik Choice Inc Medicare	$981.09
Rate for Payer: United Healthcare Commercial	$1,409.00

HC INJX PROC DUCTOGRAM/GALACTOGRAM

Facility

$473.00

Service Code	CPT 19030 TC
Hospital Charge Code	3611903001
Hospital Revenue Code	361
Min. Negotiated Rate	$65.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.93
Rate for Payer: Aetna Government	$65.93
Rate for Payer: Brighton Health Commercial	$354.75
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	$236.50
Rate for Payer: Group Health Inc Commercial	$236.50
Rate for Payer: Group Health Inc Medicare	$165.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.50
Rate for Payer: Hamaspik Choice Inc Medicare	$236.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJX PROC DUCTOGRAM/GALACTOGRAM

Facility

$473.00

Service Code	CPT 19030 TC
Hospital Charge Code	3611903001
Hospital Revenue Code	361
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$236.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$236.50

HC INJX PROCEDURE FOR CORPORA CAVERNOSOGRAPHY

Facility

$295.00

Service Code	CPT 54230 TC
Hospital Charge Code	3615423001
Hospital Revenue Code	361
Min. Negotiated Rate	$103.25
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.62
Rate for Payer: Aetna Government	$113.62
Rate for Payer: Brighton Health Commercial	$221.25
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	$147.50
Rate for Payer: Group Health Inc Commercial	$147.50
Rate for Payer: Group Health Inc Medicare	$103.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.50
Rate for Payer: Hamaspik Choice Inc Medicare	$147.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJX PROCEDURE FOR CORPORA CAVERNOSOGRAPHY

Facility

$295.00

Service Code	CPT 54230 TC
Hospital Charge Code	3615423001
Hospital Revenue Code	361
Min. Negotiated Rate	$147.50
Max. Negotiated Rate	$147.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.50

HC INJX PROCEDURE FOR MYELOGRAM, LUMBAR

Facility

$633.00

Service Code	CPT 62284 TC
Hospital Charge Code	3616228401
Hospital Revenue Code	361
Min. Negotiated Rate	$316.50
Max. Negotiated Rate	$316.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$316.50

HC INJX PROCEDURE FOR MYELOGRAM, LUMBAR

Facility

$633.00

Service Code	CPT 62284 TC
Hospital Charge Code	3616228401
Hospital Revenue Code	361
Min. Negotiated Rate	$210.19
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$210.19
Rate for Payer: Aetna Government	$210.19
Rate for Payer: Brighton Health Commercial	$474.75
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	$316.50
Rate for Payer: Group Health Inc Commercial	$316.50
Rate for Payer: Group Health Inc Medicare	$221.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$316.50
Rate for Payer: Hamaspik Choice Inc Medicare	$316.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC INJX PROC FOR TMJ ARTHOGRAPHY

Facility

$122.00

Service Code	CPT 21116 TC
Hospital Charge Code	3612111601
Hospital Revenue Code	361
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.86
Rate for Payer: Aetna Government	$147.86
Rate for Payer: Brighton Health Commercial	$91.50
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	$61.00
Rate for Payer: Group Health Inc Commercial	$61.00
Rate for Payer: Group Health Inc Medicare	$42.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00
Rate for Payer: Hamaspik Choice Inc Medicare	$61.00
Rate for Payer: United Healthcare Commercial	$1,113.00

Know your out-of-pocket cost for care.

All Charges