St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC SPINAL PUNCT DRAIN CEBROSPINE FLUID

Facility

$1,893.00

Service Code	CPT 62272
Hospital Charge Code	3616227201
Hospital Revenue Code	361
Min. Negotiated Rate	$113.67
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	$113.67
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 SPINAL PUNCT DRAIN CEBROSPINE FLUID

Facility

$1,893.00

Service Code	CPT 62272
Hospital Charge Code	3616227201
Hospital Revenue Code	361
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$946.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50

HC SPINAL PUNCTURE, LUMBAR, DX

Facility

$1,893.00

Service Code	CPT 62270 TC
Hospital Charge Code	3616227001
Hospital Revenue Code	361
Min. Negotiated Rate	$184.46
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$184.46
Rate for Payer: Aetna Government	$184.46
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 SPINAL PUNCTURE, LUMBAR, DX

Facility

$1,893.00

Service Code	CPT 62270 TC
Hospital Charge Code	3616227001
Hospital Revenue Code	361
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$946.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$946.50

HC SPLENOPORTOGRAPHY

Facility

$4,940.00

Service Code	CPT 75810 TC
Hospital Charge Code	3207581001
Hospital Revenue Code	320
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC SPLENOPORTOGRAPHY

Facility

$4,940.00

Service Code	CPT 75810 TC
Hospital Charge Code	3207581001
Hospital Revenue Code	320
Min. Negotiated Rate	$456.52
Max. Negotiated Rate	$4,336.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,112.52
Rate for Payer: Aetna Government	$2,112.52
Rate for Payer: Brighton Health Commercial	$3,705.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,336.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,650.49
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	$2,470.00
Rate for Payer: Healthfirst Essential Plan	$1,027.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$456.52

HC SPLITTING OF BLOOD OR BLOOD PRODUCTS, EACH UNIT

Facility

$493.00

Service Code	CPT 86985
Hospital Charge Code	3008698501
Hospital Revenue Code	300
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$369.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$271.15
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	$369.75
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	$20.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.61
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 SPLITTING OF BLOOD OR BLOOD PRODUCTS, EACH UNIT

Facility

$493.00

Service Code	CPT 86985
Hospital Charge Code	3008698501
Hospital Revenue Code	300
Min. Negotiated Rate	$246.50
Max. Negotiated Rate	$246.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$246.50

HC SPONTANEOUS NYSTAGMUS TEST

Facility

$330.00

Service Code	CPT 92541 TC
Hospital Charge Code	4719254101
Hospital Revenue Code	471
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC SPONTANEOUS NYSTAGMUS TEST

Facility

$330.00

Service Code	CPT 92541 TC
Hospital Charge Code	4719254101
Hospital Revenue Code	471
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$264.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$247.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.40
Rate for Payer: EmblemHealth Commercial	$165.00
Rate for Payer: Group Health Inc Commercial	$165.00
Rate for Payer: Group Health Inc Medicare	$115.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.28
Rate for Payer: United Healthcare Commercial	$158.00

HC STAB PHLEBECTOMY, VERICOSE VEINS, 1 EXTEMITY, 10-20 INCISIONS

Facility

$8,393.00

Service Code	CPT 37765 TC
Hospital Charge Code	3613776501
Hospital Revenue Code	361
Min. Negotiated Rate	$207.66
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$416.16
Rate for Payer: Aetna Government	$416.16
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	$207.66
Rate for Payer: United Healthcare Commercial	$1,835.00

HC STAB PHLEBECTOMY, VERICOSE VEINS, 1 EXTEMITY, 10-20 INCISIONS

Facility

$8,393.00

Service Code	CPT 37765 TC
Hospital Charge Code	3613776501
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 STAB PHLEBECTOMY, VERICOSE VEINS, 1 EXTEMITY, >20 INCISIONS

Facility

$8,393.00

Service Code	CPT 37766 TC
Hospital Charge Code	3613776601
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 STAB PHLEBECTOMY, VERICOSE VEINS, 1 EXTEMITY, >20 INCISIONS

Facility

$8,393.00

Service Code	CPT 37766 TC
Hospital Charge Code	3613776601
Hospital Revenue Code	361
Min. Negotiated Rate	$233.22
Max. Negotiated Rate	$6,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$707.46
Rate for Payer: Aetna Government	$707.46
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	$233.22
Rate for Payer: United Healthcare Commercial	$1,835.00

HC STAGGERED SPONDAIC WORD TEST

Facility

$419.00

Service Code	CPT 92572
Hospital Charge Code	4719257201
Hospital Revenue Code	471
Min. Negotiated Rate	$209.50
Max. Negotiated Rate	$209.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50

HC STAGGERED SPONDAIC WORD TEST

Facility

$419.00

Service Code	CPT 92572
Hospital Charge Code	4719257201
Hospital Revenue Code	471
Min. Negotiated Rate	$66.61
Max. Negotiated Rate	$335.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.17
Rate for Payer: Aetna Government	$191.17
Rate for Payer: Affinity Essential Plan 1&2	$133.82
Rate for Payer: Affinity Essential Plan 3&4	$133.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$133.82
Rate for Payer: Brighton Health Commercial	$314.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$191.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.92
Rate for Payer: Elderplan Medicare Advantage	$191.17
Rate for Payer: EmblemHealth Commercial	$191.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$172.05
Rate for Payer: Fidelis Essential Plan Aliesa	$162.49
Rate for Payer: Fidelis Essential Plan QHP	$170.14
Rate for Payer: Fidelis Medicare Advantage	$191.17
Rate for Payer: Fidelis Qualified Health Plan	$170.14
Rate for Payer: Group Health Inc Commercial	$191.17
Rate for Payer: Group Health Inc Medicare	$191.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.17
Rate for Payer: Hamaspik Choice Inc Medicare	$191.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$66.61
Rate for Payer: Healthfirst Medicare Advantage	$162.49
Rate for Payer: Healthfirst QHP	$191.17
Rate for Payer: Humana Medicare	$194.99
Rate for Payer: Senior Whole Health Medicare Advantage	$191.17
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$191.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.61
Rate for Payer: Wellcare Medicare	$181.61

HC STENGER TEST, PURE TONE

Facility

$101.00

Service Code	CPT 92565
Hospital Charge Code	4719256501
Hospital Revenue Code	471
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$50.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50

HC STENGER TEST, PURE TONE

Facility

$101.00

Service Code	CPT 92565
Hospital Charge Code	4719256501
Hospital Revenue Code	471
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$158.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.58
Rate for Payer: Aetna Government	$72.58
Rate for Payer: Affinity Essential Plan 1&2	$50.81
Rate for Payer: Affinity Essential Plan 3&4	$50.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$50.81
Rate for Payer: Brighton Health Commercial	$75.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$72.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.68
Rate for Payer: Elderplan Medicare Advantage	$72.58
Rate for Payer: EmblemHealth Commercial	$72.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65.32
Rate for Payer: Fidelis Essential Plan Aliesa	$61.69
Rate for Payer: Fidelis Essential Plan QHP	$64.60
Rate for Payer: Fidelis Medicare Advantage	$72.58
Rate for Payer: Fidelis Qualified Health Plan	$64.60
Rate for Payer: Group Health Inc Commercial	$72.58
Rate for Payer: Group Health Inc Medicare	$72.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.58
Rate for Payer: Hamaspik Choice Inc Medicare	$72.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.85
Rate for Payer: Healthfirst Medicare Advantage	$61.69
Rate for Payer: Healthfirst QHP	$72.58
Rate for Payer: Humana Medicare	$74.03
Rate for Payer: Senior Whole Health Medicare Advantage	$72.58
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$72.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68.95
Rate for Payer: Wellcare Medicare	$68.95

HC STENGER TEST, SPEECH

Facility

$1,470.00

Service Code	CPT 92577
Hospital Charge Code	4719257701
Hospital Revenue Code	471
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$1,176.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$648.30
Rate for Payer: Aetna Government	$648.30
Rate for Payer: Affinity Essential Plan 1&2	$453.81
Rate for Payer: Affinity Essential Plan 3&4	$453.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$453.81
Rate for Payer: Brighton Health Commercial	$1,102.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$648.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.60
Rate for Payer: Elderplan Medicare Advantage	$648.30
Rate for Payer: EmblemHealth Commercial	$648.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$583.47
Rate for Payer: Fidelis Essential Plan Aliesa	$551.05
Rate for Payer: Fidelis Essential Plan QHP	$576.99
Rate for Payer: Fidelis Medicare Advantage	$648.30
Rate for Payer: Fidelis Qualified Health Plan	$576.99
Rate for Payer: Group Health Inc Commercial	$648.30
Rate for Payer: Group Health Inc Medicare	$648.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$648.30
Rate for Payer: Hamaspik Choice Inc Medicare	$648.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.01
Rate for Payer: Healthfirst Medicare Advantage	$551.05
Rate for Payer: Healthfirst QHP	$648.30
Rate for Payer: Humana Medicare	$661.27
Rate for Payer: Senior Whole Health Medicare Advantage	$648.30
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$648.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$648.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$615.88
Rate for Payer: Wellcare Medicare	$615.88

HC STENGER TEST, SPEECH

Facility

$1,470.00

Service Code	CPT 92577
Hospital Charge Code	4719257701
Hospital Revenue Code	471
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.00

HC STOOL CULTURE, ADDL PATHOGENS - CULTURE, STOOL

Facility

$23.00

Service Code	CPT 87046
Hospital Charge Code	3068704601
Hospital Revenue Code	306
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$17.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.44
Rate for Payer: Aetna Government	$9.44
Rate for Payer: Affinity Essential Plan 1&2	$6.61
Rate for Payer: Affinity Essential Plan 3&4	$6.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.61
Rate for Payer: Brighton Health Commercial	$17.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.50
Rate for Payer: Elderplan Medicare Advantage	$9.44
Rate for Payer: EmblemHealth Commercial	$9.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.50
Rate for Payer: Fidelis Essential Plan Aliesa	$8.02
Rate for Payer: Fidelis Essential Plan QHP	$8.40
Rate for Payer: Fidelis Medicare Advantage	$9.44
Rate for Payer: Fidelis Qualified Health Plan	$8.40
Rate for Payer: Group Health Inc Commercial	$9.44
Rate for Payer: Group Health Inc Medicare	$9.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.44
Rate for Payer: Hamaspik Choice Inc Medicare	$9.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.98
Rate for Payer: Healthfirst Essential Plan	$6.71
Rate for Payer: Healthfirst Medicare Advantage	$9.44
Rate for Payer: Healthfirst QHP	$9.44
Rate for Payer: Humana Medicare	$9.63
Rate for Payer: Senior Whole Health Medicare Advantage	$9.44
Rate for Payer: United Healthcare Commercial	$11.95
Rate for Payer: United Healthcare Medicare Advantage	$9.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.98
Rate for Payer: Wellcare Medicare	$8.50

HC STOOL CULTURE, ADDL PATHOGENS - CULTURE, STOOL

Facility

$23.00

Service Code	CPT 87046
Hospital Charge Code	3068704601
Hospital Revenue Code	306
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$11.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.50

HC STRAPPING; ANKLE &/OR FOOT

Facility

$405.00

Service Code	CPT 29540
Hospital Charge Code	3612954001
Hospital Revenue Code	361
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.79
Rate for Payer: Aetna Government	$192.79
Rate for Payer: Affinity Essential Plan 1&2	$134.95
Rate for Payer: Affinity Essential Plan 3&4	$134.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$134.95
Rate for Payer: Brighton Health Commercial	$303.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$192.79
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	$192.79
Rate for Payer: EmblemHealth Commercial	$192.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$173.51
Rate for Payer: Fidelis Essential Plan Aliesa	$163.87
Rate for Payer: Fidelis Essential Plan QHP	$171.58
Rate for Payer: Fidelis Medicare Advantage	$192.79
Rate for Payer: Fidelis Qualified Health Plan	$171.58
Rate for Payer: Group Health Inc Commercial	$192.79
Rate for Payer: Group Health Inc Medicare	$192.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.79
Rate for Payer: Hamaspik Choice Inc Medicare	$13.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.17
Rate for Payer: Healthfirst Medicare Advantage	$163.87
Rate for Payer: Healthfirst QHP	$192.79
Rate for Payer: Humana Medicare	$196.65
Rate for Payer: Senior Whole Health Medicare Advantage	$192.79
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$192.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$183.15
Rate for Payer: Wellcare Medicare	$183.15

HC STRAPPING; ANKLE &/OR FOOT

Facility

$405.00

Service Code	CPT 29540
Hospital Charge Code	3612954001
Hospital Revenue Code	361
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.50

HC STRAPPING; ANKLE &/OR FOOT - PT

Facility

$405.00

Service Code	CPT 29540
Hospital Charge Code	4202954001
Hospital Revenue Code	420
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.50

Know your out-of-pocket cost for care.

All Charges