St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC PH BODY FLUID NOS - POCT VAGINAL PH

Facility

$8.00

Service Code	CPT 83986
Hospital Charge Code	3018398605
Hospital Revenue Code	301
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00

HC PHENOSENSE(R)

Facility

$1,221.00

Service Code	CPT 87903
Hospital Charge Code	3068790302
Hospital Revenue Code	306
Min. Negotiated Rate	$610.50
Max. Negotiated Rate	$610.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.50

HC PHENOSENSE(R)

Facility

$1,221.00

Service Code	CPT 87903
Hospital Charge Code	3068790302
Hospital Revenue Code	306
Min. Negotiated Rate	$342.06
Max. Negotiated Rate	$1,099.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$671.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$488.66
Rate for Payer: Aetna Government	$488.66
Rate for Payer: Affinity Essential Plan 1&2	$342.06
Rate for Payer: Affinity Essential Plan 3&4	$342.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$342.06
Rate for Payer: Brighton Health Commercial	$915.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$488.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$830.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$699.03
Rate for Payer: Elderplan Medicare Advantage	$488.66
Rate for Payer: EmblemHealth Commercial	$488.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$439.79
Rate for Payer: Fidelis Essential Plan Aliesa	$415.36
Rate for Payer: Fidelis Essential Plan QHP	$434.91
Rate for Payer: Fidelis Medicare Advantage	$488.66
Rate for Payer: Fidelis Qualified Health Plan	$434.91
Rate for Payer: Group Health Inc Commercial	$488.66
Rate for Payer: Group Health Inc Medicare	$488.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.66
Rate for Payer: Hamaspik Choice Inc Medicare	$488.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$488.66
Rate for Payer: Healthfirst Essential Plan	$1,099.48
Rate for Payer: Healthfirst Medicare Advantage	$488.66
Rate for Payer: Healthfirst QHP	$488.66
Rate for Payer: Humana Medicare	$498.43
Rate for Payer: Senior Whole Health Medicare Advantage	$488.66
Rate for Payer: United Healthcare Commercial	$618.87
Rate for Payer: United Healthcare Medicare Advantage	$488.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$488.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$488.66
Rate for Payer: Wellcare Medicare	$439.79

HC PHENOTYPE DNA W/DRUG RESISTANCE CULTURE ANALYSIS,HIV1

Facility

$1,221.00

Service Code	CPT 87903
Hospital Charge Code	3068790301
Hospital Revenue Code	306
Min. Negotiated Rate	$610.50
Max. Negotiated Rate	$610.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.50

HC PHENOTYPE DNA W/DRUG RESISTANCE CULTURE ANALYSIS,HIV1

Facility

$1,221.00

Service Code	CPT 87903
Hospital Charge Code	3068790301
Hospital Revenue Code	306
Min. Negotiated Rate	$342.06
Max. Negotiated Rate	$1,099.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$671.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$488.66
Rate for Payer: Aetna Government	$488.66
Rate for Payer: Affinity Essential Plan 1&2	$342.06
Rate for Payer: Affinity Essential Plan 3&4	$342.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$342.06
Rate for Payer: Brighton Health Commercial	$915.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$488.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$830.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$699.03
Rate for Payer: Elderplan Medicare Advantage	$488.66
Rate for Payer: EmblemHealth Commercial	$488.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$439.79
Rate for Payer: Fidelis Essential Plan Aliesa	$415.36
Rate for Payer: Fidelis Essential Plan QHP	$434.91
Rate for Payer: Fidelis Medicare Advantage	$488.66
Rate for Payer: Fidelis Qualified Health Plan	$434.91
Rate for Payer: Group Health Inc Commercial	$488.66
Rate for Payer: Group Health Inc Medicare	$488.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$488.66
Rate for Payer: Hamaspik Choice Inc Medicare	$488.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$488.66
Rate for Payer: Healthfirst Essential Plan	$1,099.48
Rate for Payer: Healthfirst Medicare Advantage	$488.66
Rate for Payer: Healthfirst QHP	$488.66
Rate for Payer: Humana Medicare	$498.43
Rate for Payer: Senior Whole Health Medicare Advantage	$488.66
Rate for Payer: United Healthcare Commercial	$618.87
Rate for Payer: United Healthcare Medicare Advantage	$488.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$488.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$488.66
Rate for Payer: Wellcare Medicare	$439.79

HC PHLEBOTOMY

Facility

$330.00

Service Code	CPT 99195
Hospital Charge Code	9409919501
Hospital Revenue Code	940
Min. Negotiated Rate	$105.33
Max. Negotiated Rate	$264.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.40
Rate for Payer: Elderplan Medicare Advantage	$157.49
Rate for Payer: EmblemHealth Commercial	$157.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
Rate for Payer: Group Health Inc Commercial	$157.49
Rate for Payer: Group Health Inc Medicare	$157.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$157.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$105.33
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$165.36
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Commercial	$165.00
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

HC PHLEBOTOMY

Facility

$330.00

Service Code	CPT 99195
Hospital Charge Code	9409919501
Hospital Revenue Code	940
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES

Facility

$40.00

Service Code	CPT 86148
Hospital Charge Code	3028614801
Hospital Revenue Code	302
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.00

HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES

Facility

$40.00

Service Code	CPT 86148
Hospital Charge Code	3028614801
Hospital Revenue Code	302
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$30.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.07
Rate for Payer: Aetna Government	$16.07
Rate for Payer: Affinity Essential Plan 1&2	$11.25
Rate for Payer: Affinity Essential Plan 3&4	$11.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$11.25
Rate for Payer: Brighton Health Commercial	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.99
Rate for Payer: Elderplan Medicare Advantage	$16.07
Rate for Payer: EmblemHealth Commercial	$16.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.46
Rate for Payer: Fidelis Essential Plan Aliesa	$13.66
Rate for Payer: Fidelis Essential Plan QHP	$14.30
Rate for Payer: Fidelis Medicare Advantage	$16.07
Rate for Payer: Fidelis Qualified Health Plan	$14.30
Rate for Payer: Group Health Inc Commercial	$16.07
Rate for Payer: Group Health Inc Medicare	$16.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.07
Rate for Payer: Hamaspik Choice Inc Medicare	$16.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.90
Rate for Payer: Healthfirst Essential Plan	$17.77
Rate for Payer: Healthfirst Medicare Advantage	$16.07
Rate for Payer: Healthfirst QHP	$16.07
Rate for Payer: Humana Medicare	$16.39
Rate for Payer: Senior Whole Health Medicare Advantage	$16.07
Rate for Payer: United Healthcare Commercial	$20.35
Rate for Payer: United Healthcare Medicare Advantage	$16.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.90
Rate for Payer: Wellcare Medicare	$14.46

HC PHOSPHOLIPID NEUTRALIZATION; HEXAGONAL PHOSPHOLIPID

Facility

$44.00

Service Code	CPT 85598
Hospital Charge Code	3058559801
Hospital Revenue Code	305
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00

HC PHOSPHOLIPID NEUTRALIZATION; HEXAGONAL PHOSPHOLIPID

Facility

$44.00

Service Code	CPT 85598
Hospital Charge Code	3058559801
Hospital Revenue Code	305
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$33.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.98
Rate for Payer: Aetna Government	$17.98
Rate for Payer: Affinity Essential Plan 1&2	$12.59
Rate for Payer: Affinity Essential Plan 3&4	$12.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.59
Rate for Payer: Brighton Health Commercial	$33.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.73
Rate for Payer: Elderplan Medicare Advantage	$17.98
Rate for Payer: EmblemHealth Commercial	$17.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16.18
Rate for Payer: Fidelis Essential Plan Aliesa	$15.28
Rate for Payer: Fidelis Essential Plan QHP	$16.00
Rate for Payer: Fidelis Medicare Advantage	$17.98
Rate for Payer: Fidelis Qualified Health Plan	$16.00
Rate for Payer: Group Health Inc Commercial	$17.98
Rate for Payer: Group Health Inc Medicare	$17.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.98
Rate for Payer: Hamaspik Choice Inc Medicare	$17.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17.98
Rate for Payer: Healthfirst Medicare Advantage	$17.98
Rate for Payer: Healthfirst QHP	$17.98
Rate for Payer: Humana Medicare	$18.34
Rate for Payer: Senior Whole Health Medicare Advantage	$17.98
Rate for Payer: United Healthcare Commercial	$22.77
Rate for Payer: United Healthcare Medicare Advantage	$17.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.08
Rate for Payer: Wellcare Medicare	$16.18

HC PHOSPHOLIPID NEUTRALIZATION,PLATELET - PLATELET NEUTRALIZATION

Facility

$44.00

Service Code	CPT 85597
Hospital Charge Code	3058559701
Hospital Revenue Code	305
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$33.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.98
Rate for Payer: Aetna Government	$17.98
Rate for Payer: Affinity Essential Plan 1&2	$12.59
Rate for Payer: Affinity Essential Plan 3&4	$12.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.59
Rate for Payer: Brighton Health Commercial	$33.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.73
Rate for Payer: Elderplan Medicare Advantage	$17.98
Rate for Payer: EmblemHealth Commercial	$17.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16.18
Rate for Payer: Fidelis Essential Plan Aliesa	$15.28
Rate for Payer: Fidelis Essential Plan QHP	$16.00
Rate for Payer: Fidelis Medicare Advantage	$17.98
Rate for Payer: Fidelis Qualified Health Plan	$16.00
Rate for Payer: Group Health Inc Commercial	$17.98
Rate for Payer: Group Health Inc Medicare	$17.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.98
Rate for Payer: Hamaspik Choice Inc Medicare	$17.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17.98
Rate for Payer: Healthfirst Medicare Advantage	$17.98
Rate for Payer: Healthfirst QHP	$17.98
Rate for Payer: Humana Medicare	$18.34
Rate for Payer: Senior Whole Health Medicare Advantage	$17.98
Rate for Payer: United Healthcare Commercial	$22.77
Rate for Payer: United Healthcare Medicare Advantage	$17.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.08
Rate for Payer: Wellcare Medicare	$16.18

HC PHOSPHOLIPID NEUTRALIZATION,PLATELET - PLATELET NEUTRALIZATION

Facility

$44.00

Service Code	CPT 85597
Hospital Charge Code	3058559701
Hospital Revenue Code	305
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.00

HC PHYCOANALYSIS

Facility

$397.00

Service Code	CPT 90845
Hospital Charge Code	9149084501
Hospital Revenue Code	914
Min. Negotiated Rate	$96.14
Max. Negotiated Rate	$317.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$196.31
Rate for Payer: Aetna Government	$196.31
Rate for Payer: Affinity Essential Plan 1&2	$137.42
Rate for Payer: Affinity Essential Plan 3&4	$137.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$137.42
Rate for Payer: Brighton Health Commercial	$297.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$196.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$317.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$269.96
Rate for Payer: Elderplan Medicare Advantage	$196.31
Rate for Payer: EmblemHealth Commercial	$196.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$176.68
Rate for Payer: Fidelis Essential Plan Aliesa	$166.86
Rate for Payer: Fidelis Essential Plan QHP	$174.72
Rate for Payer: Fidelis Medicare Advantage	$196.31
Rate for Payer: Fidelis Qualified Health Plan	$174.72
Rate for Payer: Group Health Inc Commercial	$196.31
Rate for Payer: Group Health Inc Medicare	$196.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$196.31
Rate for Payer: Hamaspik Choice Inc Medicare	$196.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$96.14
Rate for Payer: Healthfirst Medicare Advantage	$166.86
Rate for Payer: Healthfirst QHP	$196.31
Rate for Payer: Humana Medicare	$200.24
Rate for Payer: Senior Whole Health Medicare Advantage	$196.31
Rate for Payer: United Healthcare Medicare Advantage	$196.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$196.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$186.49
Rate for Payer: Wellcare Medicare	$186.49

HC PHYCOANALYSIS

Facility

$397.00

Service Code	CPT 90845
Hospital Charge Code	9149084501
Hospital Revenue Code	914
Min. Negotiated Rate	$198.50
Max. Negotiated Rate	$198.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$198.50

HC PHYS/QHP TELEPHONE EVALUATION 11-20 MIN

Facility

$263.00

Service Code	CPT 99442 95
Hospital Charge Code	5109944201
Hospital Revenue Code	510
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.95
Rate for Payer: Aetna Government	$18.95
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$131.50
Rate for Payer: Hamaspik Choice Inc Medicare	$131.50
Rate for Payer: United Healthcare Commercial	$222.00

HC PHYS/QHP TELEPHONE EVALUATION 11-20 MIN

Facility

$263.00

Service Code	CPT 99442 95
Hospital Charge Code	5109944201
Hospital Revenue Code	510
Min. Negotiated Rate	$131.50
Max. Negotiated Rate	$131.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.50

HC PHYS/QHP TELEPHONE EVALUATION 21-30 MIN

Facility

$395.00

Service Code	CPT 99443 95
Hospital Charge Code	5109944301
Hospital Revenue Code	510
Min. Negotiated Rate	$29.19
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.19
Rate for Payer: Aetna Government	$29.19
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50
Rate for Payer: United Healthcare Commercial	$222.00

HC PHYS/QHP TELEPHONE EVALUATION 21-30 MIN

Facility

$395.00

Service Code	CPT 99443 95
Hospital Charge Code	5109944301
Hospital Revenue Code	510
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$197.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50

HC PICC INSERTION W/O SUBCUTANEOUS PORT > 5 YRS OLD

Facility

$4,328.00

Service Code	CPT 36573 TC
Hospital Charge Code	3613657301
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$3,246.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$428.86
Rate for Payer: Aetna Government	$428.86
Rate for Payer: Brighton Health Commercial	$3,246.00
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	$2,164.00
Rate for Payer: Group Health Inc Commercial	$2,164.00
Rate for Payer: Group Health Inc Medicare	$1,514.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.00
Rate for Payer: Hamaspik Choice Inc Medicare	$632.40
Rate for Payer: United Healthcare Commercial	$1,409.00

HC PICC INSERTION W/O SUBCUTANEOUS PORT > 5 YRS OLD

Facility

$4,328.00

Service Code	CPT 36573 TC
Hospital Charge Code	3613657301
Hospital Revenue Code	361
Min. Negotiated Rate	$2,164.00
Max. Negotiated Rate	$2,164.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.00

HC PICC INSERTION W/O SUBCUTANEOUS PORT, W/O GUIDANCE < 5 YRS OLD

Facility

$4,940.00

Service Code	CPT 36568 TC
Hospital Charge Code	3613656801
Hospital Revenue Code	361
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC PICC INSERTION W/O SUBCUTANEOUS PORT, W/O GUIDANCE < 5 YRS OLD

Facility

$4,940.00

Service Code	CPT 36568 TC
Hospital Charge Code	3613656801
Hospital Revenue Code	361
Min. Negotiated Rate	$322.56
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$322.56
Rate for Payer: Aetna Government	$322.56
Rate for Payer: Brighton Health Commercial	$3,705.00
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	$2,470.00
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$632.40
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PICC INSERTION W/O SUBCUTANEOUS PORT, W/O GUIDANCE > 5 YRS OLD

Facility

$4,940.00

Service Code	CPT 36569 TC
Hospital Charge Code	3613656901
Hospital Revenue Code	361
Min. Negotiated Rate	$267.57
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$267.57
Rate for Payer: Aetna Government	$267.57
Rate for Payer: Brighton Health Commercial	$3,705.00
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	$2,470.00
Rate for Payer: Group Health Inc Commercial	$2,470.00
Rate for Payer: Group Health Inc Medicare	$1,729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$632.40
Rate for Payer: United Healthcare Commercial	$1,188.00

HC PICC INSERTION W/O SUBCUTANEOUS PORT, W/O GUIDANCE > 5 YRS OLD

Facility

$4,940.00

Service Code	CPT 36569 TC
Hospital Charge Code	3613656901
Hospital Revenue Code	361
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

Know your out-of-pocket cost for care.

All Charges