St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC TRANSCERVICAL INTRODUCTION FALLOPIAN TUBE CATHETER

Facility

$7,566.00

Service Code	CPT 58345 TC
Hospital Charge Code	3615834501
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 TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,DELIVERY/MANAGEMENT

Facility

$980.00

Service Code	CPT 90868
Hospital Charge Code	9009086801
Hospital Revenue Code	900
Min. Negotiated Rate	$266.33
Max. Negotiated Rate	$784.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$539.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$380.47
Rate for Payer: Aetna Government	$380.47
Rate for Payer: Affinity Essential Plan 1&2	$266.33
Rate for Payer: Affinity Essential Plan 3&4	$266.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$266.33
Rate for Payer: Brighton Health Commercial	$735.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$380.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$784.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$666.40
Rate for Payer: Elderplan Medicare Advantage	$380.47
Rate for Payer: EmblemHealth Commercial	$380.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.42
Rate for Payer: Fidelis Essential Plan Aliesa	$323.40
Rate for Payer: Fidelis Essential Plan QHP	$338.62
Rate for Payer: Fidelis Medicare Advantage	$380.47
Rate for Payer: Fidelis Qualified Health Plan	$338.62
Rate for Payer: Group Health Inc Commercial	$380.47
Rate for Payer: Group Health Inc Medicare	$380.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.47
Rate for Payer: Hamaspik Choice Inc Medicare	$380.47
Rate for Payer: Healthfirst Medicare Advantage	$323.40
Rate for Payer: Healthfirst QHP	$380.47
Rate for Payer: Humana Medicare	$388.08
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$399.49
Rate for Payer: Senior Whole Health Medicare Advantage	$380.47
Rate for Payer: United Healthcare Commercial	$490.00
Rate for Payer: United Healthcare Medicare Advantage	$380.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$380.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.45
Rate for Payer: Wellcare Medicare	$361.45

HC TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,DELIVERY/MANAGEMENT

Facility

$980.00

Service Code	CPT 90868
Hospital Charge Code	9009086801
Hospital Revenue Code	900
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.00

HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)

Facility

$13.00

Service Code	CPT 84460
Hospital Charge Code	3018446001
Hospital Revenue Code	301
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$11.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.30
Rate for Payer: Aetna Government	$5.30
Rate for Payer: Affinity Essential Plan 1&2	$3.71
Rate for Payer: Affinity Essential Plan 3&4	$3.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.71
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.57
Rate for Payer: Elderplan Medicare Advantage	$5.30
Rate for Payer: EmblemHealth Commercial	$5.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.77
Rate for Payer: Fidelis Essential Plan Aliesa	$4.50
Rate for Payer: Fidelis Essential Plan QHP	$4.72
Rate for Payer: Fidelis Medicare Advantage	$5.30
Rate for Payer: Fidelis Qualified Health Plan	$4.72
Rate for Payer: Group Health Inc Commercial	$5.30
Rate for Payer: Group Health Inc Medicare	$5.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.30
Rate for Payer: Hamaspik Choice Inc Medicare	$5.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.08
Rate for Payer: Healthfirst Essential Plan	$11.43
Rate for Payer: Healthfirst Medicare Advantage	$5.30
Rate for Payer: Healthfirst QHP	$5.30
Rate for Payer: Humana Medicare	$5.41
Rate for Payer: Senior Whole Health Medicare Advantage	$5.30
Rate for Payer: United Healthcare Commercial	$6.70
Rate for Payer: United Healthcare Medicare Advantage	$5.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.08
Rate for Payer: Wellcare Medicare	$4.77

HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)

Facility

$13.00

Service Code	CPT 84460
Hospital Charge Code	3018446001
Hospital Revenue Code	301
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50

HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)

Facility

$12.00

Service Code	CPT 84450
Hospital Charge Code	3018445001
Hospital Revenue Code	301
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$11.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.18
Rate for Payer: Aetna Government	$5.18
Rate for Payer: Affinity Essential Plan 1&2	$3.63
Rate for Payer: Affinity Essential Plan 3&4	$3.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.63
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.41
Rate for Payer: Elderplan Medicare Advantage	$5.18
Rate for Payer: EmblemHealth Commercial	$5.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4.66
Rate for Payer: Fidelis Essential Plan Aliesa	$4.40
Rate for Payer: Fidelis Essential Plan QHP	$4.61
Rate for Payer: Fidelis Medicare Advantage	$5.18
Rate for Payer: Fidelis Qualified Health Plan	$4.61
Rate for Payer: Group Health Inc Commercial	$5.18
Rate for Payer: Group Health Inc Medicare	$5.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.18
Rate for Payer: Hamaspik Choice Inc Medicare	$5.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.08
Rate for Payer: Healthfirst Essential Plan	$11.43
Rate for Payer: Healthfirst Medicare Advantage	$5.18
Rate for Payer: Healthfirst QHP	$5.18
Rate for Payer: Humana Medicare	$5.28
Rate for Payer: Senior Whole Health Medicare Advantage	$5.18
Rate for Payer: United Healthcare Commercial	$6.55
Rate for Payer: United Healthcare Medicare Advantage	$5.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.08
Rate for Payer: Wellcare Medicare	$4.66

HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)

Facility

$12.00

Service Code	CPT 84450
Hospital Charge Code	3018445001
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

HC TRANSLUMINAL BALLOON ANGIO, 1ST ARTERY (EXCL LOWER EXT)

Facility

$15,004.00

Service Code	CPT 37246
Hospital Charge Code	3613724601
Hospital Revenue Code	361
Min. Negotiated Rate	$7,502.00
Max. Negotiated Rate	$7,502.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.00

HC TRANSLUMINAL BALLOON ANGIO, 1ST ARTERY (EXCL LOWER EXT)

Facility

$15,004.00

Service Code	CPT 37246
Hospital Charge Code	3613724601
Hospital Revenue Code	361
Min. Negotiated Rate	$396.17
Max. Negotiated Rate	$11,253.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,966.23
Rate for Payer: Aetna Government	$6,966.23
Rate for Payer: Affinity Essential Plan 1&2	$4,876.36
Rate for Payer: Affinity Essential Plan 3&4	$4,876.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,876.36
Rate for Payer: Brighton Health Commercial	$11,253.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,966.23
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	$6,966.23
Rate for Payer: EmblemHealth Commercial	$6,966.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6,269.61
Rate for Payer: Fidelis Essential Plan Aliesa	$5,921.30
Rate for Payer: Fidelis Essential Plan QHP	$6,199.94
Rate for Payer: Fidelis Medicare Advantage	$6,966.23
Rate for Payer: Fidelis Qualified Health Plan	$6,199.94
Rate for Payer: Group Health Inc Commercial	$6,966.23
Rate for Payer: Group Health Inc Medicare	$6,966.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,966.23
Rate for Payer: Hamaspik Choice Inc Medicare	$3,422.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$396.17
Rate for Payer: Healthfirst Medicare Advantage	$5,921.30
Rate for Payer: Healthfirst QHP	$6,966.23
Rate for Payer: Humana Medicare	$7,105.55
Rate for Payer: Senior Whole Health Medicare Advantage	$6,966.23
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$6,966.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,966.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,617.92
Rate for Payer: Wellcare Medicare	$6,617.92

HC TRANSLUMINAL BALLOON ANGIO, 1ST ARTERY (NOT DIALYSIS)

Facility

$15,004.00

Service Code	CPT 37248
Hospital Charge Code	3613724801
Hospital Revenue Code	361
Min. Negotiated Rate	$331.42
Max. Negotiated Rate	$11,253.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,966.23
Rate for Payer: Aetna Government	$6,966.23
Rate for Payer: Affinity Essential Plan 1&2	$4,876.36
Rate for Payer: Affinity Essential Plan 3&4	$4,876.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,876.36
Rate for Payer: Brighton Health Commercial	$11,253.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,966.23
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	$6,966.23
Rate for Payer: EmblemHealth Commercial	$6,966.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6,269.61
Rate for Payer: Fidelis Essential Plan Aliesa	$5,921.30
Rate for Payer: Fidelis Essential Plan QHP	$6,199.94
Rate for Payer: Fidelis Medicare Advantage	$6,966.23
Rate for Payer: Fidelis Qualified Health Plan	$6,199.94
Rate for Payer: Group Health Inc Commercial	$6,966.23
Rate for Payer: Group Health Inc Medicare	$6,966.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,966.23
Rate for Payer: Hamaspik Choice Inc Medicare	$3,320.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$331.42
Rate for Payer: Healthfirst Medicare Advantage	$5,921.30
Rate for Payer: Healthfirst QHP	$6,966.23
Rate for Payer: Humana Medicare	$7,105.55
Rate for Payer: Senior Whole Health Medicare Advantage	$6,966.23
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$6,966.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,966.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,617.92
Rate for Payer: Wellcare Medicare	$6,617.92

HC TRANSLUMINAL BALLOON ANGIO, 1ST ARTERY (NOT DIALYSIS)

Facility

$15,004.00

Service Code	CPT 37248
Hospital Charge Code	3613724801
Hospital Revenue Code	361
Min. Negotiated Rate	$7,502.00
Max. Negotiated Rate	$7,502.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.00

HC TRANSLUMINAL BALLOON ANGIO, CENTRAL DIALYSIS SEG, ADD-ON

Facility

$345.00

Service Code	CPT 36907
Hospital Charge Code	3613690701
Hospital Revenue Code	361
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50

HC TRANSLUMINAL BALLOON ANGIO, CENTRAL DIALYSIS SEG, ADD-ON

Facility

$345.00

Service Code	CPT 36907
Hospital Charge Code	3613690701
Hospital Revenue Code	361
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$5,593.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.44
Rate for Payer: Aetna Government	$135.44
Rate for Payer: Brighton Health Commercial	$258.75
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	$172.50
Rate for Payer: Group Health Inc Commercial	$172.50
Rate for Payer: Group Health Inc Medicare	$120.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.50
Rate for Payer: Hamaspik Choice Inc Medicare	$172.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164.85
Rate for Payer: United Healthcare Commercial	$1,113.00

HC TRANSLUMINAL BALLOON ANGIO, EACH ADD'L ARTERY (EXCL LOWER EXT)

Facility

$487.00

Service Code	CPT 37247
Hospital Charge Code	3613724701
Hospital Revenue Code	361
Min. Negotiated Rate	$170.45
Max. Negotiated Rate	$5,593.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$191.71
Rate for Payer: Aetna Government	$191.71
Rate for Payer: Brighton Health Commercial	$365.25
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	$243.50
Rate for Payer: Group Health Inc Commercial	$243.50
Rate for Payer: Group Health Inc Medicare	$170.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.50
Rate for Payer: Hamaspik Choice Inc Medicare	$243.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$196.78
Rate for Payer: United Healthcare Commercial	$1,113.00

HC TRANSLUMINAL BALLOON ANGIO, EACH ADD'L ARTERY (EXCL LOWER EXT)

Facility

$487.00

Service Code	CPT 37247
Hospital Charge Code	3613724701
Hospital Revenue Code	361
Min. Negotiated Rate	$243.50
Max. Negotiated Rate	$243.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.50

HC TRANSLUMINAL BALLOON ANGIO, EACH ADD'L ARTERY (NOT DIALYSIS)

Facility

$414.00

Service Code	CPT 37249
Hospital Charge Code	3613724901
Hospital Revenue Code	361
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$207.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.00

HC TRANSLUMINAL BALLOON ANGIO, EACH ADD'L ARTERY (NOT DIALYSIS)

Facility

$414.00

Service Code	CPT 37249
Hospital Charge Code	3613724901
Hospital Revenue Code	361
Min. Negotiated Rate	$144.90
Max. Negotiated Rate	$5,593.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$163.16
Rate for Payer: Aetna Government	$163.16
Rate for Payer: Brighton Health Commercial	$310.50
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	$207.00
Rate for Payer: Group Health Inc Commercial	$207.00
Rate for Payer: Group Health Inc Medicare	$144.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.00
Rate for Payer: Hamaspik Choice Inc Medicare	$207.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.97
Rate for Payer: United Healthcare Commercial	$1,113.00

HC TRANS OF PORTABLE MAMMO EQUIPMENT

Facility

$70.00

Service Code	CPT R0075
Hospital Charge Code	329R007501
Hospital Revenue Code	329
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00

HC TRANS OF PORTABLE MAMMO EQUIPMENT

Facility

$70.00

Service Code	CPT R0075
Hospital Charge Code	329R007501
Hospital Revenue Code	329
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$56.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Brighton Health Commercial	$52.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.60
Rate for Payer: EmblemHealth Commercial	$35.00
Rate for Payer: Group Health Inc Commercial	$35.00
Rate for Payer: Group Health Inc Medicare	$24.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.00
Rate for Payer: Hamaspik Choice Inc Medicare	$35.00

HC TRANSRECT DRAINAGE PELVIC ABSCESS

Facility

$3,041.00

Service Code	CPT 45000 TC
Hospital Charge Code	3614500001
Hospital Revenue Code	361
Min. Negotiated Rate	$1,520.50
Max. Negotiated Rate	$1,520.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.50

HC TRANSRECT DRAINAGE PELVIC ABSCESS

Facility

$3,041.00

Service Code	CPT 45000 TC
Hospital Charge Code	3614500001
Hospital Revenue Code	361
Min. Negotiated Rate	$493.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$493.93
Rate for Payer: Aetna Government	$493.93
Rate for Payer: Brighton Health Commercial	$2,280.75
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	$1,520.50
Rate for Payer: Group Health Inc Commercial	$1,520.50
Rate for Payer: Group Health Inc Medicare	$1,064.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,520.50
Rate for Payer: Hamaspik Choice Inc Medicare	$632.96
Rate for Payer: United Healthcare Commercial	$1,409.00

HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76817 TC
Hospital Charge Code	4027681701
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76817 TC
Hospital Charge Code	4027681701
Hospital Revenue Code	402
Min. Negotiated Rate	$46.72
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.72
Rate for Payer: Aetna Government	$46.72
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: EmblemHealth Commercial	$59.25
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.25
Rate for Payer: Healthfirst Essential Plan	$231.50
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$102.89

HC TRANSVASC PLACEMENT INTRAVASCULAR STENT, ADD'L VEIN

Facility

$13,095.00

Service Code	CPT 37239 TC
Hospital Charge Code	3613723901
Hospital Revenue Code	361
Min. Negotiated Rate	$6,547.50
Max. Negotiated Rate	$6,547.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,547.50

HC TRANSVASC PLACEMENT INTRAVASCULAR STENT, ADD'L VEIN

Facility

$13,095.00

Service Code	CPT 37239 TC
Hospital Charge Code	3613723901
Hospital Revenue Code	361
Min. Negotiated Rate	$2,203.84
Max. Negotiated Rate	$9,821.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,203.84
Rate for Payer: Aetna Government	$2,203.84
Rate for Payer: Brighton Health Commercial	$9,821.25
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	$6,547.50
Rate for Payer: Group Health Inc Commercial	$6,547.50
Rate for Payer: Group Health Inc Medicare	$4,583.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,547.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6,547.50
Rate for Payer: United Healthcare Commercial	$2,546.00

Know your out-of-pocket cost for care.

All Charges