St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA

Facility

$5,176.00

Service Code	CPT 15851
Hospital Charge Code	3611585101
Hospital Revenue Code	361
Min. Negotiated Rate	$2,588.00
Max. Negotiated Rate	$2,588.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,588.00

HC REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA

Facility

$5,176.00

Service Code	CPT 15851
Hospital Charge Code	3611585101
Hospital Revenue Code	361
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$3,882.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,234.99
Rate for Payer: Aetna Government	$2,234.99
Rate for Payer: Affinity Essential Plan 1&2	$1,564.49
Rate for Payer: Affinity Essential Plan 3&4	$1,564.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,564.49
Rate for Payer: Brighton Health Commercial	$3,882.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,234.99
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	$2,234.99
Rate for Payer: EmblemHealth Commercial	$2,234.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,011.49
Rate for Payer: Fidelis Essential Plan Aliesa	$1,899.74
Rate for Payer: Fidelis Essential Plan QHP	$1,989.14
Rate for Payer: Fidelis Medicare Advantage	$2,234.99
Rate for Payer: Fidelis Qualified Health Plan	$1,989.14
Rate for Payer: Group Health Inc Commercial	$2,234.99
Rate for Payer: Group Health Inc Medicare	$2,234.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,234.99
Rate for Payer: Hamaspik Choice Inc Medicare	$15.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$74.65
Rate for Payer: Healthfirst Medicare Advantage	$1,899.74
Rate for Payer: Healthfirst QHP	$2,234.99
Rate for Payer: Humana Medicare	$2,279.69
Rate for Payer: Senior Whole Health Medicare Advantage	$2,234.99
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,234.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,234.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,123.24
Rate for Payer: Wellcare Medicare	$2,123.24

HC REMOVAL PERM PACEMAKER PULSE GEN ONLY

Facility

$23,145.00

Service Code	CPT 33233
Hospital Charge Code	3613323301
Hospital Revenue Code	361
Min. Negotiated Rate	$11,572.50
Max. Negotiated Rate	$11,572.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,572.50

HC REMOVAL PERM PACEMAKER PULSE GEN ONLY

Facility

$23,145.00

Service Code	CPT 33233
Hospital Charge Code	3613323301
Hospital Revenue Code	361
Min. Negotiated Rate	$272.00
Max. Negotiated Rate	$17,358.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10,111.76
Rate for Payer: Aetna Government	$10,111.76
Rate for Payer: Affinity Essential Plan 1&2	$7,078.23
Rate for Payer: Affinity Essential Plan 3&4	$7,078.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$7,078.23
Rate for Payer: Brighton Health Commercial	$17,358.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10,111.76
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	$10,111.76
Rate for Payer: EmblemHealth Commercial	$10,111.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9,100.58
Rate for Payer: Fidelis Essential Plan Aliesa	$8,595.00
Rate for Payer: Fidelis Essential Plan QHP	$8,999.47
Rate for Payer: Fidelis Medicare Advantage	$10,111.76
Rate for Payer: Fidelis Qualified Health Plan	$8,999.47
Rate for Payer: Group Health Inc Commercial	$10,111.76
Rate for Payer: Group Health Inc Medicare	$10,111.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,111.76
Rate for Payer: Hamaspik Choice Inc Medicare	$5,506.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$272.00
Rate for Payer: Healthfirst Medicare Advantage	$8,595.00
Rate for Payer: Healthfirst QHP	$10,111.76
Rate for Payer: Humana Medicare	$10,314.00
Rate for Payer: Senior Whole Health Medicare Advantage	$10,111.76
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$10,111.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,111.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9,606.17
Rate for Payer: Wellcare Medicare	$9,606.17

HC REMOVAL PERQ LEFT HEART VAD

Facility

$598.00

Service Code	CPT 33992
Hospital Charge Code	3613399201
Hospital Revenue Code	361
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$328.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$232.79
Rate for Payer: Aetna Government	$232.79
Rate for Payer: Brighton Health Commercial	$448.50
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	$299.00
Rate for Payer: Group Health Inc Commercial	$299.00
Rate for Payer: Group Health Inc Medicare	$209.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.00
Rate for Payer: Hamaspik Choice Inc Medicare	$299.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$217.00
Rate for Payer: United Healthcare Commercial	$1,496.00

HC REMOVAL PERQ LEFT HEART VAD

Facility

$598.00

Service Code	CPT 33992
Hospital Charge Code	3613399201
Hospital Revenue Code	361
Min. Negotiated Rate	$299.00
Max. Negotiated Rate	$299.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.00

HC REMOVAL RECTAL OBSTRUCTION

Facility

$3,041.00

Service Code	CPT 45915
Hospital Charge Code	7504591501
Hospital Revenue Code	750
Min. Negotiated Rate	$1,520.50
Max. Negotiated Rate	$1,520.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.50

HC REMOVAL RECTAL OBSTRUCTION

Facility

$3,041.00

Service Code	CPT 45915
Hospital Charge Code	7504591501
Hospital Revenue Code	750
Min. Negotiated Rate	$270.42
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,440.62
Rate for Payer: Aetna Government	$1,440.62
Rate for Payer: Affinity Essential Plan 1&2	$1,008.43
Rate for Payer: Affinity Essential Plan 3&4	$1,008.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,008.43
Rate for Payer: Brighton Health Commercial	$2,280.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,440.62
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	$1,440.62
Rate for Payer: EmblemHealth Commercial	$1,440.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,296.56
Rate for Payer: Fidelis Essential Plan Aliesa	$1,224.53
Rate for Payer: Fidelis Essential Plan QHP	$1,282.15
Rate for Payer: Fidelis Medicare Advantage	$1,440.62
Rate for Payer: Fidelis Qualified Health Plan	$1,282.15
Rate for Payer: Group Health Inc Commercial	$1,440.62
Rate for Payer: Group Health Inc Medicare	$1,440.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,440.62
Rate for Payer: Hamaspik Choice Inc Medicare	$632.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$270.42
Rate for Payer: Healthfirst Medicare Advantage	$1,224.53
Rate for Payer: Healthfirst QHP	$1,440.62
Rate for Payer: Humana Medicare	$1,469.43
Rate for Payer: Senior Whole Health Medicare Advantage	$1,440.62
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,440.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,440.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,368.59
Rate for Payer: Wellcare Medicare	$1,368.59

HC REMOVAL SUPERFICIAL IMPLANT

Facility

$4,157.00

Service Code	CPT 20670
Hospital Charge Code	3612067002
Hospital Revenue Code	361
Min. Negotiated Rate	$2,078.50
Max. Negotiated Rate	$2,078.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.50

HC REMOVAL SUPERFICIAL IMPLANT

Facility

$4,157.00

Service Code	CPT 20670
Hospital Charge Code	3612067002
Hospital Revenue Code	361
Min. Negotiated Rate	$170.19
Max. Negotiated Rate	$3,117.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,979.64
Rate for Payer: Aetna Government	$1,979.64
Rate for Payer: Affinity Essential Plan 1&2	$1,385.75
Rate for Payer: Affinity Essential Plan 3&4	$1,385.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,385.75
Rate for Payer: Brighton Health Commercial	$3,117.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,979.64
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	$1,979.64
Rate for Payer: EmblemHealth Commercial	$1,979.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,781.68
Rate for Payer: Fidelis Essential Plan Aliesa	$1,682.69
Rate for Payer: Fidelis Essential Plan QHP	$1,761.88
Rate for Payer: Fidelis Medicare Advantage	$1,979.64
Rate for Payer: Fidelis Qualified Health Plan	$1,761.88
Rate for Payer: Group Health Inc Commercial	$1,979.64
Rate for Payer: Group Health Inc Medicare	$1,979.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,979.64
Rate for Payer: Hamaspik Choice Inc Medicare	$708.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$170.19
Rate for Payer: Healthfirst Medicare Advantage	$1,682.69
Rate for Payer: Healthfirst QHP	$1,979.64
Rate for Payer: Humana Medicare	$2,019.23
Rate for Payer: Senior Whole Health Medicare Advantage	$1,979.64
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,979.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,979.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,880.66
Rate for Payer: Wellcare Medicare	$1,880.66

HC REMOVAL SWEAT GLAND LESION, COMPLETE REPAIR

Facility

$7,023.00

Service Code	CPT 11451
Hospital Charge Code	3611145101
Hospital Revenue Code	361
Min. Negotiated Rate	$3,511.50
Max. Negotiated Rate	$3,511.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,511.50

HC REMOVAL SWEAT GLAND LESION, COMPLETE REPAIR

Facility

$7,023.00

Service Code	CPT 11451
Hospital Charge Code	3611145101
Hospital Revenue Code	361
Min. Negotiated Rate	$396.10
Max. Negotiated Rate	$5,267.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,496.91
Rate for Payer: Aetna Government	$3,496.91
Rate for Payer: Affinity Essential Plan 1&2	$2,447.84
Rate for Payer: Affinity Essential Plan 3&4	$2,447.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,447.84
Rate for Payer: Brighton Health Commercial	$5,267.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,496.91
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	$3,496.91
Rate for Payer: EmblemHealth Commercial	$3,496.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,147.22
Rate for Payer: Fidelis Essential Plan Aliesa	$2,972.37
Rate for Payer: Fidelis Essential Plan QHP	$3,112.25
Rate for Payer: Fidelis Medicare Advantage	$3,496.91
Rate for Payer: Fidelis Qualified Health Plan	$3,112.25
Rate for Payer: Group Health Inc Commercial	$3,496.91
Rate for Payer: Group Health Inc Medicare	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,496.91
Rate for Payer: Hamaspik Choice Inc Medicare	$1,201.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$396.10
Rate for Payer: Healthfirst Medicare Advantage	$2,972.37
Rate for Payer: Healthfirst QHP	$3,496.91
Rate for Payer: Humana Medicare	$3,566.85
Rate for Payer: Senior Whole Health Medicare Advantage	$3,496.91
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,496.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,496.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,322.06
Rate for Payer: Wellcare Medicare	$3,322.06

HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP

Facility

$1,909.00

Service Code	CPT 36589 TC
Hospital Charge Code	3613658901
Hospital Revenue Code	361
Min. Negotiated Rate	$177.79
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.79
Rate for Payer: Aetna Government	$177.79
Rate for Payer: Brighton Health Commercial	$1,431.75
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	$954.50
Rate for Payer: Group Health Inc Commercial	$954.50
Rate for Payer: Group Health Inc Medicare	$668.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50
Rate for Payer: Hamaspik Choice Inc Medicare	$332.31
Rate for Payer: United Healthcare Commercial	$1,188.00

HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP

Facility

$1,909.00

Service Code	CPT 36589 TC
Hospital Charge Code	3613658901
Hospital Revenue Code	361
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP

Facility

$1,909.00

Service Code	CPT 36590
Hospital Charge Code	3613659001
Hospital Revenue Code	361
Min. Negotiated Rate	$954.50
Max. Negotiated Rate	$954.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.50

HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP

Facility

$1,909.00

Service Code	CPT 36590
Hospital Charge Code	3613659001
Hospital Revenue Code	361
Min. Negotiated Rate	$217.96
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,898.02
Rate for Payer: Aetna Government	$1,898.02
Rate for Payer: Affinity Essential Plan 1&2	$1,328.61
Rate for Payer: Affinity Essential Plan 3&4	$1,328.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,328.61
Rate for Payer: Brighton Health Commercial	$1,431.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,898.02
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	$1,898.02
Rate for Payer: EmblemHealth Commercial	$1,898.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,708.22
Rate for Payer: Fidelis Essential Plan Aliesa	$1,613.32
Rate for Payer: Fidelis Essential Plan QHP	$1,689.24
Rate for Payer: Fidelis Medicare Advantage	$1,898.02
Rate for Payer: Fidelis Qualified Health Plan	$1,689.24
Rate for Payer: Group Health Inc Commercial	$1,898.02
Rate for Payer: Group Health Inc Medicare	$1,898.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,898.02
Rate for Payer: Hamaspik Choice Inc Medicare	$632.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$217.96
Rate for Payer: Healthfirst Medicare Advantage	$1,613.32
Rate for Payer: Healthfirst QHP	$1,898.02
Rate for Payer: Humana Medicare	$1,935.98
Rate for Payer: Senior Whole Health Medicare Advantage	$1,898.02
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,898.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,898.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,803.12
Rate for Payer: Wellcare Medicare	$1,803.12

HC REMOVAL TUNNELED INTRAPERITONEAL CATHETER

Facility

$8,393.00

Service Code	CPT 49422 TC
Hospital Charge Code	3614942201
Hospital Revenue Code	361
Min. Negotiated Rate	$450.55
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.55
Rate for Payer: Aetna Government	$450.55
Rate for Payer: Brighton Health Commercial	$6,294.75
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	$4,196.50
Rate for Payer: Group Health Inc Commercial	$4,196.50
Rate for Payer: Group Health Inc Medicare	$2,937.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,588.69
Rate for Payer: United Healthcare Commercial	$1,835.00

HC REMOVAL TUNNELED INTRAPERITONEAL CATHETER

Facility

$8,393.00

Service Code	CPT 49422 TC
Hospital Charge Code	3614942201
Hospital Revenue Code	361
Min. Negotiated Rate	$4,196.50
Max. Negotiated Rate	$4,196.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.50

HC REMOVAL VAGINAL FOR.BODY W ANESTH

Facility

$7,566.00

Service Code	CPT 57415
Hospital Charge Code	3615741501
Hospital Revenue Code	361
Min. Negotiated Rate	$203.66
Max. Negotiated Rate	$5,674.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
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	$5,674.50
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	$203.66
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 REMOVAL VAGINAL FOR.BODY W ANESTH

Facility

$7,566.00

Service Code	CPT 57415
Hospital Charge Code	3615741501
Hospital Revenue Code	361
Min. Negotiated Rate	$3,783.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.00

HC REMOVE CVA DEVICE OBSTRUCT - IR CATHETER OBSTRUCTION REMOVAL

Facility

$705.00

Service Code	CPT 75901 TC
Hospital Charge Code	3217590101
Hospital Revenue Code	321
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC REMOVE CVA DEVICE OBSTRUCT - IR CATHETER OBSTRUCTION REMOVAL

Facility

$705.00

Service Code	CPT 75901 TC
Hospital Charge Code	3217590101
Hospital Revenue Code	321
Min. Negotiated Rate	$108.52
Max. Negotiated Rate	$564.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.64
Rate for Payer: Aetna Government	$120.64
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: EmblemHealth Commercial	$210.01
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$210.01
Rate for Payer: Healthfirst Essential Plan	$244.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$108.52

HC REMOVE DRUG IMPLANT DEVICE

Facility

$1,101.00

Service Code	CPT 11982
Hospital Charge Code	3611198201
Hospital Revenue Code	361
Min. Negotiated Rate	$550.50
Max. Negotiated Rate	$550.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.50

HC REMOVE DRUG IMPLANT DEVICE

Facility

$1,101.00

Service Code	CPT 11982
Hospital Charge Code	3611198201
Hospital Revenue Code	361
Min. Negotiated Rate	$84.06
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$487.56
Rate for Payer: Aetna Government	$487.56
Rate for Payer: Affinity Essential Plan 1&2	$341.29
Rate for Payer: Affinity Essential Plan 3&4	$341.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$341.29
Rate for Payer: Brighton Health Commercial	$825.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$487.56
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	$487.56
Rate for Payer: EmblemHealth Commercial	$487.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$438.80
Rate for Payer: Fidelis Essential Plan Aliesa	$414.43
Rate for Payer: Fidelis Essential Plan QHP	$433.93
Rate for Payer: Fidelis Medicare Advantage	$487.56
Rate for Payer: Fidelis Qualified Health Plan	$433.93
Rate for Payer: Group Health Inc Commercial	$487.56
Rate for Payer: Group Health Inc Medicare	$487.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$487.56
Rate for Payer: Hamaspik Choice Inc Medicare	$487.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$84.06
Rate for Payer: Healthfirst Medicare Advantage	$414.43
Rate for Payer: Healthfirst QHP	$487.56
Rate for Payer: Humana Medicare	$497.31
Rate for Payer: Senior Whole Health Medicare Advantage	$487.56
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$487.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$487.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$463.18
Rate for Payer: Wellcare Medicare	$463.18

HC REMOVE EYELID LESION

Facility

$2,444.00

Service Code	CPT 67840
Hospital Charge Code	5106784001
Hospital Revenue Code	510
Min. Negotiated Rate	$1,222.00
Max. Negotiated Rate	$1,222.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.00

Know your out-of-pocket cost for care.

All Charges