St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM

Facility

$967.00

Service Code	CPT 12053
Hospital Charge Code	3611205302
Hospital Revenue Code	361
Min. Negotiated Rate	$214.39
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$488.15
Rate for Payer: Aetna Government	$488.15
Rate for Payer: Affinity Essential Plan 1&2	$341.70
Rate for Payer: Affinity Essential Plan 3&4	$341.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$341.70
Rate for Payer: Brighton Health Commercial	$725.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$488.15
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	$488.15
Rate for Payer: EmblemHealth Commercial	$488.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$439.33
Rate for Payer: Fidelis Essential Plan Aliesa	$414.93
Rate for Payer: Fidelis Essential Plan QHP	$434.45
Rate for Payer: Fidelis Medicare Advantage	$488.15
Rate for Payer: Fidelis Qualified Health Plan	$434.45
Rate for Payer: Group Health Inc Commercial	$488.15
Rate for Payer: Group Health Inc Medicare	$488.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.15
Rate for Payer: Hamaspik Choice Inc Medicare	$214.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$247.04
Rate for Payer: Healthfirst Medicare Advantage	$414.93
Rate for Payer: Healthfirst QHP	$488.15
Rate for Payer: Humana Medicare	$497.91
Rate for Payer: Senior Whole Health Medicare Advantage	$488.15
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$488.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$488.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$463.74
Rate for Payer: Wellcare Medicare	$463.74

HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM

Facility

$967.00

Service Code	CPT 12053
Hospital Charge Code	3611205302
Hospital Revenue Code	361
Min. Negotiated Rate	$483.50
Max. Negotiated Rate	$483.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.50

HC LEFORT I MAXILLA-SEGMENTED

Facility

$7,250.00

Service Code	CPT D7947
Hospital Charge Code	361D794701
Hospital Revenue Code	361
Min. Negotiated Rate	$2,537.50
Max. Negotiated Rate	$5,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,987.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,563.69
Rate for Payer: Aetna Government	$2,563.69
Rate for Payer: Brighton Health Commercial	$5,437.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,930.00
Rate for Payer: EmblemHealth Commercial	$3,625.00
Rate for Payer: Group Health Inc Commercial	$3,625.00
Rate for Payer: Group Health Inc Medicare	$2,537.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,625.00

HC LEFORT I MAXILLA-SEGMENTED

Facility

$7,250.00

Service Code	CPT D7947
Hospital Charge Code	361D794701
Hospital Revenue Code	361
Min. Negotiated Rate	$3,625.00
Max. Negotiated Rate	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00

HC LEFORT I MAXILLA-TOTAL

Facility

$5,437.00

Service Code	CPT D7946
Hospital Charge Code	361D794601
Hospital Revenue Code	361
Min. Negotiated Rate	$1,902.95
Max. Negotiated Rate	$4,349.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,990.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,048.52
Rate for Payer: Aetna Government	$3,048.52
Rate for Payer: Brighton Health Commercial	$4,077.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,349.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,697.16
Rate for Payer: EmblemHealth Commercial	$2,718.50
Rate for Payer: Group Health Inc Commercial	$2,718.50
Rate for Payer: Group Health Inc Medicare	$1,902.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,718.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,718.50

HC LEFORT I MAXILLA-TOTAL

Facility

$5,437.00

Service Code	CPT D7946
Hospital Charge Code	361D794601
Hospital Revenue Code	361
Min. Negotiated Rate	$2,718.50
Max. Negotiated Rate	$2,718.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,718.50

HC LEGIONELLA - LEGIONELLA PNEUMOPHILA TOTL AB

Facility

$38.00

Service Code	CPT 86713
Hospital Charge Code	3028671301
Hospital Revenue Code	302
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.00

HC LEGIONELLA - LEGIONELLA PNEUMOPHILA TOTL AB

Facility

$38.00

Service Code	CPT 86713
Hospital Charge Code	3028671301
Hospital Revenue Code	302
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$34.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.30
Rate for Payer: Aetna Government	$15.30
Rate for Payer: Affinity Essential Plan 1&2	$10.71
Rate for Payer: Affinity Essential Plan 3&4	$10.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.71
Rate for Payer: Brighton Health Commercial	$28.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.88
Rate for Payer: Elderplan Medicare Advantage	$15.30
Rate for Payer: EmblemHealth Commercial	$15.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.77
Rate for Payer: Fidelis Essential Plan Aliesa	$13.01
Rate for Payer: Fidelis Essential Plan QHP	$13.62
Rate for Payer: Fidelis Medicare Advantage	$15.30
Rate for Payer: Fidelis Qualified Health Plan	$13.62
Rate for Payer: Group Health Inc Commercial	$15.30
Rate for Payer: Group Health Inc Medicare	$15.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.30
Rate for Payer: Hamaspik Choice Inc Medicare	$15.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.30
Rate for Payer: Healthfirst Essential Plan	$34.42
Rate for Payer: Healthfirst Medicare Advantage	$15.30
Rate for Payer: Healthfirst QHP	$15.30
Rate for Payer: Humana Medicare	$15.61
Rate for Payer: Senior Whole Health Medicare Advantage	$15.30
Rate for Payer: United Healthcare Commercial	$19.38
Rate for Payer: United Healthcare Medicare Advantage	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.30
Rate for Payer: Wellcare Medicare	$13.77

HC LEGION PNEUMO AG, DFA - LEGIONELLA PNEUMOPHILA ANTIGEN

Facility

$41.00

Service Code	CPT 87278
Hospital Charge Code	3068727801
Hospital Revenue Code	306
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$20.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.50

HC LEGION PNEUMO AG, DFA - LEGIONELLA PNEUMOPHILA ANTIGEN

Facility

$41.00

Service Code	CPT 87278
Hospital Charge Code	3068727801
Hospital Revenue Code	306
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$35.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.60
Rate for Payer: Aetna Government	$15.60
Rate for Payer: Affinity Essential Plan 1&2	$10.92
Rate for Payer: Affinity Essential Plan 3&4	$10.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.92
Rate for Payer: Brighton Health Commercial	$30.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.15
Rate for Payer: Elderplan Medicare Advantage	$15.60
Rate for Payer: EmblemHealth Commercial	$15.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.04
Rate for Payer: Fidelis Essential Plan Aliesa	$13.26
Rate for Payer: Fidelis Essential Plan QHP	$13.88
Rate for Payer: Fidelis Medicare Advantage	$15.60
Rate for Payer: Fidelis Qualified Health Plan	$13.88
Rate for Payer: Group Health Inc Commercial	$15.60
Rate for Payer: Group Health Inc Medicare	$15.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.60
Rate for Payer: Hamaspik Choice Inc Medicare	$15.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.60
Rate for Payer: Healthfirst Essential Plan	$35.10
Rate for Payer: Healthfirst Medicare Advantage	$15.60
Rate for Payer: Healthfirst QHP	$15.60
Rate for Payer: Humana Medicare	$15.91
Rate for Payer: Senior Whole Health Medicare Advantage	$15.60
Rate for Payer: United Healthcare Commercial	$15.19
Rate for Payer: United Healthcare Medicare Advantage	$15.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.60
Rate for Payer: Wellcare Medicare	$14.04

HC LEPTOSPIRA - LEPTOSPIRA ANTIBODY

Facility

$40.00

Service Code	CPT 86720
Hospital Charge Code	3028672001
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$30.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.20
Rate for Payer: Aetna Government	$16.20
Rate for Payer: Affinity Essential Plan 1&2	$11.34
Rate for Payer: Affinity Essential Plan 3&4	$11.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.34
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.86
Rate for Payer: Elderplan Medicare Advantage	$16.20
Rate for Payer: EmblemHealth Commercial	$16.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.58
Rate for Payer: Fidelis Essential Plan Aliesa	$13.77
Rate for Payer: Fidelis Essential Plan QHP	$14.42
Rate for Payer: Fidelis Medicare Advantage	$16.20
Rate for Payer: Fidelis Qualified Health Plan	$14.42
Rate for Payer: Group Health Inc Commercial	$16.20
Rate for Payer: Group Health Inc Medicare	$16.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.20
Rate for Payer: Hamaspik Choice Inc Medicare	$16.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.11
Rate for Payer: Healthfirst Essential Plan	$18.25
Rate for Payer: Healthfirst Medicare Advantage	$16.20
Rate for Payer: Healthfirst QHP	$16.20
Rate for Payer: Humana Medicare	$16.52
Rate for Payer: Senior Whole Health Medicare Advantage	$16.20
Rate for Payer: United Healthcare Commercial	$16.70
Rate for Payer: United Healthcare Medicare Advantage	$16.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.11
Rate for Payer: Wellcare Medicare	$14.58

HC LEPTOSPIRA - LEPTOSPIRA ANTIBODY

Facility

$40.00

Service Code	CPT 86720
Hospital Charge Code	3028672001
Hospital Revenue Code	302
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00

HC LEUKOCYTE COUNT,FECAL - FECAL LEUKOCYTES

Facility

$52.00

Service Code	CPT 89055
Hospital Charge Code	3008905501
Hospital Revenue Code	300
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$39.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.27
Rate for Payer: Aetna Government	$4.27
Rate for Payer: Affinity Essential Plan 1&2	$2.99
Rate for Payer: Affinity Essential Plan 3&4	$2.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.99
Rate for Payer: Brighton Health Commercial	$39.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.11
Rate for Payer: Elderplan Medicare Advantage	$4.27
Rate for Payer: EmblemHealth Commercial	$4.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.84
Rate for Payer: Fidelis Essential Plan Aliesa	$3.63
Rate for Payer: Fidelis Essential Plan QHP	$3.80
Rate for Payer: Fidelis Medicare Advantage	$4.27
Rate for Payer: Fidelis Qualified Health Plan	$3.80
Rate for Payer: Group Health Inc Commercial	$4.27
Rate for Payer: Group Health Inc Medicare	$4.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.27
Rate for Payer: Hamaspik Choice Inc Medicare	$4.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.43
Rate for Payer: Healthfirst Essential Plan	$7.72
Rate for Payer: Healthfirst Medicare Advantage	$4.27
Rate for Payer: Healthfirst QHP	$4.27
Rate for Payer: Humana Medicare	$4.36
Rate for Payer: Senior Whole Health Medicare Advantage	$4.27
Rate for Payer: United Healthcare Commercial	$5.41
Rate for Payer: United Healthcare Medicare Advantage	$4.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.43
Rate for Payer: Wellcare Medicare	$3.84

HC LEUKOCYTE COUNT,FECAL - FECAL LEUKOCYTES

Facility

$52.00

Service Code	CPT 89055
Hospital Charge Code	3008905501
Hospital Revenue Code	300
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$26.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.00

HC LEUKOCYTE HISTMINE RELEASE TEST (LHR)

Facility

$31.00

Service Code	CPT 86343
Hospital Charge Code	3028634301
Hospital Revenue Code	302
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$23.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.46
Rate for Payer: Aetna Government	$12.46
Rate for Payer: Affinity Essential Plan 1&2	$8.72
Rate for Payer: Affinity Essential Plan 3&4	$8.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.72
Rate for Payer: Brighton Health Commercial	$23.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.83
Rate for Payer: Elderplan Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$12.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$11.21
Rate for Payer: Fidelis Essential Plan Aliesa	$10.59
Rate for Payer: Fidelis Essential Plan QHP	$11.09
Rate for Payer: Fidelis Medicare Advantage	$12.46
Rate for Payer: Fidelis Qualified Health Plan	$11.09
Rate for Payer: Group Health Inc Commercial	$12.46
Rate for Payer: Group Health Inc Medicare	$12.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.46
Rate for Payer: Hamaspik Choice Inc Medicare	$12.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.46
Rate for Payer: Healthfirst Medicare Advantage	$12.46
Rate for Payer: Healthfirst QHP	$12.46
Rate for Payer: Humana Medicare	$12.71
Rate for Payer: Senior Whole Health Medicare Advantage	$12.46
Rate for Payer: United Healthcare Commercial	$15.79
Rate for Payer: United Healthcare Medicare Advantage	$12.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.84
Rate for Payer: Wellcare Medicare	$11.21

HC LEUKOCYTE HISTMINE RELEASE TEST (LHR)

Facility

$31.00

Service Code	CPT 86343
Hospital Charge Code	3028634301
Hospital Revenue Code	302
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$15.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.50

HC LEUKOCYTE TRANSFUSION

Facility

$434.00

Service Code	CPT 86950
Hospital Charge Code	3008695001
Hospital Revenue Code	300
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$325.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.37
Rate for Payer: Aetna Government	$209.37
Rate for Payer: Affinity Essential Plan 1&2	$146.56
Rate for Payer: Affinity Essential Plan 3&4	$146.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.56
Rate for Payer: Brighton Health Commercial	$325.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$209.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.82
Rate for Payer: Elderplan Medicare Advantage	$209.37
Rate for Payer: EmblemHealth Commercial	$209.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$188.43
Rate for Payer: Fidelis Essential Plan Aliesa	$177.96
Rate for Payer: Fidelis Essential Plan QHP	$186.34
Rate for Payer: Fidelis Medicare Advantage	$209.37
Rate for Payer: Fidelis Qualified Health Plan	$186.34
Rate for Payer: Group Health Inc Commercial	$209.37
Rate for Payer: Group Health Inc Medicare	$209.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.37
Rate for Payer: Hamaspik Choice Inc Medicare	$209.37
Rate for Payer: Healthfirst Medicare Advantage	$209.37
Rate for Payer: Healthfirst QHP	$209.37
Rate for Payer: Humana Medicare	$213.56
Rate for Payer: Senior Whole Health Medicare Advantage	$209.37
Rate for Payer: United Healthcare Commercial	$13.44
Rate for Payer: United Healthcare Medicare Advantage	$209.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$209.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$198.90
Rate for Payer: Wellcare Medicare	$188.43

HC LEUKOCYTE TRANSFUSION

Facility

$434.00

Service Code	CPT 86950
Hospital Charge Code	3008695001
Hospital Revenue Code	300
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.00

HC LEUKOCYTE (WBC) COUNT - WHITE BLOOD COUNT AND DIFFERENTIAL

Facility

$6.00

Service Code	CPT 85048
Hospital Charge Code	3058504801
Hospital Revenue Code	305
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$5.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.54
Rate for Payer: Aetna Government	$2.54
Rate for Payer: Affinity Essential Plan 1&2	$1.78
Rate for Payer: Affinity Essential Plan 3&4	$1.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.78
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.63
Rate for Payer: Elderplan Medicare Advantage	$2.54
Rate for Payer: EmblemHealth Commercial	$2.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.29
Rate for Payer: Fidelis Essential Plan Aliesa	$2.16
Rate for Payer: Fidelis Essential Plan QHP	$2.26
Rate for Payer: Fidelis Medicare Advantage	$2.54
Rate for Payer: Fidelis Qualified Health Plan	$2.26
Rate for Payer: Group Health Inc Commercial	$2.54
Rate for Payer: Group Health Inc Medicare	$2.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.54
Rate for Payer: Hamaspik Choice Inc Medicare	$2.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.54
Rate for Payer: Healthfirst Essential Plan	$5.71
Rate for Payer: Healthfirst Medicare Advantage	$2.54
Rate for Payer: Healthfirst QHP	$2.54
Rate for Payer: Humana Medicare	$2.59
Rate for Payer: Senior Whole Health Medicare Advantage	$2.54
Rate for Payer: United Healthcare Commercial	$3.21
Rate for Payer: United Healthcare Medicare Advantage	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.54
Rate for Payer: Wellcare Medicare	$2.29

HC LEUKOCYTE (WBC) COUNT - WHITE BLOOD COUNT AND DIFFERENTIAL

Facility

$6.00

Service Code	CPT 85048
Hospital Charge Code	3058504801
Hospital Revenue Code	305
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00

HC LEVEEN/SHUNT PATENCY - NM ABDOMEN PERITONEAL VENOUS SHUNT PATENCY

Facility

$1,114.00

Service Code	CPT 78291 TC
Hospital Charge Code	3407829101
Hospital Revenue Code	340
Min. Negotiated Rate	$557.00
Max. Negotiated Rate	$557.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00

HC LEVEEN/SHUNT PATENCY - NM ABDOMEN PERITONEAL VENOUS SHUNT PATENCY

Facility

$1,114.00

Service Code	CPT 78291 TC
Hospital Charge Code	3407829101
Hospital Revenue Code	340
Min. Negotiated Rate	$144.15
Max. Negotiated Rate	$835.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.15
Rate for Payer: Aetna Government	$144.15
Rate for Payer: Brighton Health Commercial	$835.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$512.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$431.05
Rate for Payer: EmblemHealth Commercial	$206.94
Rate for Payer: Group Health Inc Commercial	$557.00
Rate for Payer: Group Health Inc Medicare	$389.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00
Rate for Payer: Hamaspik Choice Inc Medicare	$557.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$206.94
Rate for Payer: Healthfirst Essential Plan	$367.22
Rate for Payer: United Healthcare Commercial	$191.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.21

HC LIGATE FALLOPIAN TUBE,POSTPARTUM

Facility

$5,268.00

Service Code	CPT 58605
Hospital Charge Code	3615860501
Hospital Revenue Code	361
Min. Negotiated Rate	$391.94
Max. Negotiated Rate	$3,951.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,897.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$404.99
Rate for Payer: Aetna Government	$404.99
Rate for Payer: Brighton Health Commercial	$3,951.00
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	$2,634.00
Rate for Payer: Group Health Inc Commercial	$2,634.00
Rate for Payer: Group Health Inc Medicare	$1,843.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,634.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,634.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$391.94
Rate for Payer: United Healthcare Commercial	$1,409.00

HC LIGATE FALLOPIAN TUBE,POSTPARTUM

Facility

$5,268.00

Service Code	CPT 58605
Hospital Charge Code	3615860501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,634.00
Max. Negotiated Rate	$2,634.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,634.00

HC LIGATION OF COMMON ILLIAC VEIN

Facility

$3,327.00

Service Code	CPT 37660 TC
Hospital Charge Code	3613766001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,663.50
Max. Negotiated Rate	$1,663.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,663.50

Know your out-of-pocket cost for care.

All Charges