St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC T CELLS, TOTAL COUNT - T CELLS, TOTAL COUNT - LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$94.00

Service Code	CPT 86359
Hospital Charge Code	3028635902
Hospital Revenue Code	302
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$47.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00

HC T CELLS, TOTAL COUNT - T CELLS, TOTAL COUNT - LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$94.00

Service Code	CPT 86359
Hospital Charge Code	3028635902
Hospital Revenue Code	302
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$70.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.73
Rate for Payer: Aetna Government	$37.73
Rate for Payer: Affinity Essential Plan 1&2	$26.41
Rate for Payer: Affinity Essential Plan 3&4	$26.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$26.41
Rate for Payer: Brighton Health Commercial	$70.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$37.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.96
Rate for Payer: Elderplan Medicare Advantage	$37.73
Rate for Payer: EmblemHealth Commercial	$37.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33.96
Rate for Payer: Fidelis Essential Plan Aliesa	$32.07
Rate for Payer: Fidelis Essential Plan QHP	$33.58
Rate for Payer: Fidelis Medicare Advantage	$37.73
Rate for Payer: Fidelis Qualified Health Plan	$33.58
Rate for Payer: Group Health Inc Commercial	$37.73
Rate for Payer: Group Health Inc Medicare	$37.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.73
Rate for Payer: Hamaspik Choice Inc Medicare	$37.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23.40
Rate for Payer: Healthfirst Essential Plan	$52.65
Rate for Payer: Healthfirst Medicare Advantage	$37.73
Rate for Payer: Healthfirst QHP	$37.73
Rate for Payer: Humana Medicare	$38.48
Rate for Payer: Senior Whole Health Medicare Advantage	$37.73
Rate for Payer: United Healthcare Commercial	$47.77
Rate for Payer: United Healthcare Medicare Advantage	$37.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.40
Rate for Payer: Wellcare Medicare	$33.96

HC T CELLS, TOTAL COUNT - T CELLS, TOTAL COUNT - T4/T8 LYMPHO

Facility

$94.00

Service Code	CPT 86359
Hospital Charge Code	3028635901
Hospital Revenue Code	302
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$47.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00

HC T CELLS, TOTAL COUNT - T CELLS, TOTAL COUNT - T4/T8 LYMPHO

Facility

$94.00

Service Code	CPT 86359
Hospital Charge Code	3028635901
Hospital Revenue Code	302
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$70.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.73
Rate for Payer: Aetna Government	$37.73
Rate for Payer: Affinity Essential Plan 1&2	$26.41
Rate for Payer: Affinity Essential Plan 3&4	$26.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$26.41
Rate for Payer: Brighton Health Commercial	$70.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$37.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.96
Rate for Payer: Elderplan Medicare Advantage	$37.73
Rate for Payer: EmblemHealth Commercial	$37.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33.96
Rate for Payer: Fidelis Essential Plan Aliesa	$32.07
Rate for Payer: Fidelis Essential Plan QHP	$33.58
Rate for Payer: Fidelis Medicare Advantage	$37.73
Rate for Payer: Fidelis Qualified Health Plan	$33.58
Rate for Payer: Group Health Inc Commercial	$37.73
Rate for Payer: Group Health Inc Medicare	$37.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.73
Rate for Payer: Hamaspik Choice Inc Medicare	$37.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23.40
Rate for Payer: Healthfirst Essential Plan	$52.65
Rate for Payer: Healthfirst Medicare Advantage	$37.73
Rate for Payer: Healthfirst QHP	$37.73
Rate for Payer: Humana Medicare	$38.48
Rate for Payer: Senior Whole Health Medicare Advantage	$37.73
Rate for Payer: United Healthcare Commercial	$47.77
Rate for Payer: United Healthcare Medicare Advantage	$37.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.40
Rate for Payer: Wellcare Medicare	$33.96

HC TDAP VACCINE >7 YO, IM

Facility

$74.00

Service Code	CPT 90715
Hospital Charge Code	6369071501
Hospital Revenue Code	636
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$48.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.80
Rate for Payer: Aetna Government	$35.80
Rate for Payer: Brighton Health Commercial	$44.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.55
Rate for Payer: EmblemHealth Commercial	$37.00
Rate for Payer: Group Health Inc Commercial	$37.00
Rate for Payer: Group Health Inc Medicare	$25.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.10

HC TDAP VACCINE >7 YO, IM

Facility

$74.00

Service Code	CPT 90715
Hospital Charge Code	6369071501
Hospital Revenue Code	636
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00
Rate for Payer: Hamaspik Choice Inc Medicare	$37.00

HC TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE

Facility

$75.00

Service Code	CPT 90714
Hospital Charge Code	6369071401
Hospital Revenue Code	636
Min. Negotiated Rate	$26.22
Max. Negotiated Rate	$48.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$45.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.12
Rate for Payer: EmblemHealth Commercial	$37.50
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.75

HC TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE

Facility

$75.00

Service Code	CPT 90714
Hospital Charge Code	6369071401
Hospital Revenue Code	636
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

HC TELEHEALTH FACILITY FEE

Facility

$130.00

Service Code	CPT Q3014
Hospital Charge Code	780Q301401
Hospital Revenue Code	780
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00

HC TELEHEALTH FACILITY FEE

Facility

$130.00

Service Code	CPT Q3014
Hospital Charge Code	780Q301401
Hospital Revenue Code	780
Min. Negotiated Rate	$26.02
Max. Negotiated Rate	$2,602.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.65
Rate for Payer: Aetna Government	$26.65
Rate for Payer: Affinity Essential Plan 1&2	$58.55
Rate for Payer: Affinity Essential Plan 3&4	$58.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$26.02
Rate for Payer: Amida Care Medicaid	$26.02
Rate for Payer: Brighton Health Commercial	$97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.40
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$58.55
Rate for Payer: EmblemHealth Essential Plan 3&4	$26.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.02
Rate for Payer: Fidelis Essential Plan Aliesa	$58.55
Rate for Payer: Fidelis Essential Plan QHP	$58.55
Rate for Payer: Fidelis Qualified Health Plan	$27.32
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.02
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,602.00
Rate for Payer: Healthfirst Essential Plan	$58.55
Rate for Payer: Healthfirst QHP	$42.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.02
Rate for Payer: SOMOS Essential	$58.55
Rate for Payer: United Healthcare Essential Plan 1&2	$58.55
Rate for Payer: United Healthcare Essential Plan 3&4	$28.62
Rate for Payer: United Healthcare Medicaid	$26.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.02

HC TELEPHONIC 5-10MINS MEDCL DISCUSS

Facility

$131.00

Service Code	CPT 99441 95
Hospital Charge Code	5109944101
Hospital Revenue Code	510
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$65.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.50

HC TELEPHONIC 5-10MINS MEDCL DISCUSS

Facility

$131.00

Service Code	CPT 99441 95
Hospital Charge Code	5109944101
Hospital Revenue Code	510
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.24
Rate for Payer: Aetna Government	$10.24
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	$65.50
Rate for Payer: Hamaspik Choice Inc Medicare	$65.50
Rate for Payer: United Healthcare Commercial	$222.00

HC TEMP TRANSCUTANEOUS PACING

Facility

$1,624.00

Service Code	CPT 92953
Hospital Charge Code	4809295301
Hospital Revenue Code	480
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1,299.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.53
Rate for Payer: Aetna Government	$799.53
Rate for Payer: Affinity Essential Plan 1&2	$559.67
Rate for Payer: Affinity Essential Plan 3&4	$559.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.67
Rate for Payer: Brighton Health Commercial	$1,218.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,299.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,104.32
Rate for Payer: Elderplan Medicare Advantage	$799.53
Rate for Payer: EmblemHealth Commercial	$799.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$719.58
Rate for Payer: Fidelis Essential Plan Aliesa	$679.60
Rate for Payer: Fidelis Essential Plan QHP	$711.58
Rate for Payer: Fidelis Medicare Advantage	$799.53
Rate for Payer: Fidelis Qualified Health Plan	$711.58
Rate for Payer: Group Health Inc Commercial	$799.53
Rate for Payer: Group Health Inc Medicare	$799.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$799.53
Rate for Payer: Hamaspik Choice Inc Medicare	$799.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.35
Rate for Payer: Healthfirst Medicare Advantage	$679.60
Rate for Payer: Healthfirst QHP	$799.53
Rate for Payer: Humana Medicare	$815.52
Rate for Payer: Senior Whole Health Medicare Advantage	$799.53
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$799.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$759.55
Rate for Payer: Wellcare Medicare	$759.55

HC TEMP TRANSCUTANEOUS PACING

Facility

$1,624.00

Service Code	CPT 92953
Hospital Charge Code	4809295301
Hospital Revenue Code	480
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$812.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.00

HC TENDON EXCISION PALM/FINGER, EACH TENDON

Facility

$4,105.00

Service Code	CPT 26145
Hospital Charge Code	3612614501
Hospital Revenue Code	361
Min. Negotiated Rate	$2,052.50
Max. Negotiated Rate	$2,052.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,052.50

HC TENDON EXCISION PALM/FINGER, EACH TENDON

Facility

$4,105.00

Service Code	CPT 26145
Hospital Charge Code	3612614501
Hospital Revenue Code	361
Min. Negotiated Rate	$621.00
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,955.41
Rate for Payer: Aetna Government	$1,955.41
Rate for Payer: Affinity Essential Plan 1&2	$1,368.79
Rate for Payer: Affinity Essential Plan 3&4	$1,368.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,368.79
Rate for Payer: Brighton Health Commercial	$3,078.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,955.41
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	$1,955.41
Rate for Payer: EmblemHealth Commercial	$1,955.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,759.87
Rate for Payer: Fidelis Essential Plan Aliesa	$1,662.10
Rate for Payer: Fidelis Essential Plan QHP	$1,740.31
Rate for Payer: Fidelis Medicare Advantage	$1,955.41
Rate for Payer: Fidelis Qualified Health Plan	$1,740.31
Rate for Payer: Group Health Inc Commercial	$1,955.41
Rate for Payer: Group Health Inc Medicare	$1,955.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,955.41
Rate for Payer: Hamaspik Choice Inc Medicare	$838.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$621.00
Rate for Payer: Healthfirst Medicare Advantage	$1,662.10
Rate for Payer: Healthfirst QHP	$1,955.41
Rate for Payer: Humana Medicare	$1,994.52
Rate for Payer: Senior Whole Health Medicare Advantage	$1,955.41
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,955.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,955.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,857.64
Rate for Payer: Wellcare Medicare	$1,857.64

HC TENOTOMY, PERCUTANEOUS, TOE, SINGLE TENDON

Facility

$4,105.00

Service Code	CPT 28010
Hospital Charge Code	3612801001
Hospital Revenue Code	361
Min. Negotiated Rate	$126.80
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,955.41
Rate for Payer: Aetna Government	$1,955.41
Rate for Payer: Affinity Essential Plan 1&2	$1,368.79
Rate for Payer: Affinity Essential Plan 3&4	$1,368.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,368.79
Rate for Payer: Brighton Health Commercial	$3,078.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,955.41
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	$1,955.41
Rate for Payer: EmblemHealth Commercial	$1,955.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,759.87
Rate for Payer: Fidelis Essential Plan Aliesa	$1,662.10
Rate for Payer: Fidelis Essential Plan QHP	$1,740.31
Rate for Payer: Fidelis Medicare Advantage	$1,955.41
Rate for Payer: Fidelis Qualified Health Plan	$1,740.31
Rate for Payer: Group Health Inc Commercial	$1,955.41
Rate for Payer: Group Health Inc Medicare	$1,955.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,955.41
Rate for Payer: Hamaspik Choice Inc Medicare	$126.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$240.81
Rate for Payer: Healthfirst Medicare Advantage	$1,662.10
Rate for Payer: Healthfirst QHP	$1,955.41
Rate for Payer: Humana Medicare	$1,994.52
Rate for Payer: Senior Whole Health Medicare Advantage	$1,955.41
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$1,955.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,955.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,857.64
Rate for Payer: Wellcare Medicare	$1,857.64

HC TENOTOMY, PERCUTANEOUS, TOE, SINGLE TENDON

Facility

$4,105.00

Service Code	CPT 28010
Hospital Charge Code	3612801001
Hospital Revenue Code	361
Min. Negotiated Rate	$2,052.50
Max. Negotiated Rate	$2,052.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,052.50

HC TEST FOR URINE CYSTINES - CYSTINE URINE QUALITATIVE

Facility

$46.00

Service Code	CPT 82615
Hospital Charge Code	3018261501
Hospital Revenue Code	301
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$34.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.55
Rate for Payer: Aetna Government	$9.55
Rate for Payer: Affinity Essential Plan 1&2	$6.68
Rate for Payer: Affinity Essential Plan 3&4	$6.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.68
Rate for Payer: Brighton Health Commercial	$34.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.66
Rate for Payer: Elderplan Medicare Advantage	$9.55
Rate for Payer: EmblemHealth Commercial	$9.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.60
Rate for Payer: Fidelis Essential Plan Aliesa	$8.12
Rate for Payer: Fidelis Essential Plan QHP	$8.50
Rate for Payer: Fidelis Medicare Advantage	$9.55
Rate for Payer: Fidelis Qualified Health Plan	$8.50
Rate for Payer: Group Health Inc Commercial	$9.55
Rate for Payer: Group Health Inc Medicare	$9.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.55
Rate for Payer: Hamaspik Choice Inc Medicare	$9.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.07
Rate for Payer: Healthfirst Essential Plan	$15.91
Rate for Payer: Healthfirst Medicare Advantage	$9.55
Rate for Payer: Healthfirst QHP	$9.55
Rate for Payer: Humana Medicare	$9.74
Rate for Payer: Senior Whole Health Medicare Advantage	$9.55
Rate for Payer: United Healthcare Commercial	$10.33
Rate for Payer: United Healthcare Medicare Advantage	$9.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.07
Rate for Payer: Wellcare Medicare	$8.60

HC TEST FOR URINE CYSTINES - CYSTINE URINE QUALITATIVE

Facility

$46.00

Service Code	CPT 82615
Hospital Charge Code	3018261501
Hospital Revenue Code	301
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$23.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00

HC TESTICULAR IMAGING & FLOW - NM TESTICLE WITH FLOW

Facility

$1,114.00

Service Code	CPT 78761 TC
Hospital Charge Code	3407876102
Hospital Revenue Code	340
Min. Negotiated Rate	$118.86
Max. Negotiated Rate	$835.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.86
Rate for Payer: Aetna Government	$118.86
Rate for Payer: Brighton Health Commercial	$835.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$687.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$579.04
Rate for Payer: EmblemHealth Commercial	$169.56
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	$169.56
Rate for Payer: Healthfirst Essential Plan	$350.66
Rate for Payer: United Healthcare Commercial	$257.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$155.85

HC TESTICULAR IMAGING & FLOW - NM TESTICLE WITH FLOW

Facility

$1,114.00

Service Code	CPT 78761 TC
Hospital Charge Code	3407876102
Hospital Revenue Code	340
Min. Negotiated Rate	$557.00
Max. Negotiated Rate	$557.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00

HC TETNUS IMMUNE GLOBIN

Facility

$107.00

Service Code	CPT 90389
Hospital Charge Code	6369038901
Hospital Revenue Code	636
Min. Negotiated Rate	$53.50
Max. Negotiated Rate	$53.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50
Rate for Payer: Hamaspik Choice Inc Medicare	$53.50

HC TETNUS IMMUNE GLOBIN

Facility

$107.00

Service Code	CPT 90389
Hospital Charge Code	6369038901
Hospital Revenue Code	636
Min. Negotiated Rate	$37.45
Max. Negotiated Rate	$595.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$595.90
Rate for Payer: Aetna Government	$595.90
Rate for Payer: Brighton Health Commercial	$64.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.52
Rate for Payer: EmblemHealth Commercial	$53.50
Rate for Payer: Group Health Inc Commercial	$53.50
Rate for Payer: Group Health Inc Medicare	$37.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50
Rate for Payer: Hamaspik Choice Inc Medicare	$53.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$69.55

HC THEAPUTIC ENEMA, AIR , CONTRAST FOR OBSTRUCTION REDUCTION

Facility

$551.00

Service Code	CPT 74283 TC
Hospital Charge Code	3207428301
Hospital Revenue Code	320
Min. Negotiated Rate	$80.20
Max. Negotiated Rate	$413.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.20
Rate for Payer: Aetna Government	$80.20
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.21
Rate for Payer: EmblemHealth Commercial	$167.54
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$167.54
Rate for Payer: Healthfirst Essential Plan	$330.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.92

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