St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC TTE F-UP OR LMTD - TTE LIMITED

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330807
Hospital Revenue Code	483
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC TTE F-UP OR LMTD - TTE LIMITED

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330807
Hospital Revenue Code	483
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.95
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC TTE F-UP OR LMTD - TTE LIMITED W/ COLOR

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330809
Hospital Revenue Code	483
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC TTE F-UP OR LMTD - TTE LIMITED W/ COLOR

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330809
Hospital Revenue Code	483
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.95
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC TTE F-UP OR LMTD - TTE LIMITED W/ CONTRAST

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330808
Hospital Revenue Code	483
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.95
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC TTE F-UP OR LMTD - TTE LIMITED W/ CONTRAST

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330808
Hospital Revenue Code	483
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC TTE F-UP OR LMTD - TTE LIMITED W/ DOPPLER AND COLOR

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330810
Hospital Revenue Code	483
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC TTE F-UP OR LMTD - TTE LIMITED W/ DOPPLER AND COLOR

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330810
Hospital Revenue Code	483
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.95
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC TTE F-UP OR LMTD - TTE LIMITED W/ DOPPLER, COLOR AND CONTRAST

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330811
Hospital Revenue Code	483
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC TTE F-UP OR LMTD - TTE LIMITED W/ DOPPLER, COLOR AND CONTRAST

Facility

$705.00

Service Code	CPT 93308
Hospital Charge Code	4839330811
Hospital Revenue Code	483
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.95
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC TTE W/DOPPLER COMPLETE - TRANSTHORACIC ECHO (TTE) COMPLETE

Facility

$1,458.00

Service Code	CPT 93306 TC
Hospital Charge Code	4839330601
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC TTE W/DOPPLER COMPLETE - TRANSTHORACIC ECHO (TTE) COMPLETE

Facility

$1,458.00

Service Code	CPT 93306 TC
Hospital Charge Code	4839330601
Hospital Revenue Code	483
Min. Negotiated Rate	$147.48
Max. Negotiated Rate	$1,166.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.48
Rate for Payer: Aetna Government	$147.48
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: EmblemHealth Commercial	$729.00
Rate for Payer: Group Health Inc Commercial	$729.00
Rate for Payer: Group Health Inc Medicare	$510.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00
Rate for Payer: Hamaspik Choice Inc Medicare	$729.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$147.80
Rate for Payer: United Healthcare Commercial	$569.00

HC TTE W/DOPPLER COMPLETE - TTE COMPLETE

Facility

$1,458.00

Service Code	CPT 93306 TC
Hospital Charge Code	4839330602
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC TTE W/DOPPLER COMPLETE - TTE COMPLETE

Facility

$1,458.00

Service Code	CPT 93306 TC
Hospital Charge Code	4839330602
Hospital Revenue Code	483
Min. Negotiated Rate	$147.48
Max. Negotiated Rate	$1,166.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.48
Rate for Payer: Aetna Government	$147.48
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: EmblemHealth Commercial	$729.00
Rate for Payer: Group Health Inc Commercial	$729.00
Rate for Payer: Group Health Inc Medicare	$510.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00
Rate for Payer: Hamaspik Choice Inc Medicare	$729.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$147.80
Rate for Payer: United Healthcare Commercial	$569.00

HC TTE W/DOPPLER COMPLETE - TTE COMPLETE W/ CONTRAST

Facility

$1,458.00

Service Code	CPT 93306 TC
Hospital Charge Code	4839330603
Hospital Revenue Code	483
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$729.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00

HC TTE W/DOPPLER COMPLETE - TTE COMPLETE W/ CONTRAST

Facility

$1,458.00

Service Code	CPT 93306 TC
Hospital Charge Code	4839330603
Hospital Revenue Code	483
Min. Negotiated Rate	$147.48
Max. Negotiated Rate	$1,166.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$801.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.48
Rate for Payer: Aetna Government	$147.48
Rate for Payer: Brighton Health Commercial	$1,093.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.44
Rate for Payer: EmblemHealth Commercial	$729.00
Rate for Payer: Group Health Inc Commercial	$729.00
Rate for Payer: Group Health Inc Medicare	$510.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.00
Rate for Payer: Hamaspik Choice Inc Medicare	$729.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$147.80
Rate for Payer: United Healthcare Commercial	$569.00

HC TTE W/O DOPPLER COMPLETE - TTE COMPLETE NO DOPPLER NO COLOR

Facility

$705.00

Service Code	CPT 93307
Hospital Charge Code	4839330702
Hospital Revenue Code	483
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$1,412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.34
Rate for Payer: Aetna Government	$295.34
Rate for Payer: Affinity Essential Plan 1&2	$206.74
Rate for Payer: Affinity Essential Plan 3&4	$206.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$206.74
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$295.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.40
Rate for Payer: Elderplan Medicare Advantage	$295.34
Rate for Payer: EmblemHealth Commercial	$295.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$265.81
Rate for Payer: Fidelis Essential Plan Aliesa	$251.04
Rate for Payer: Fidelis Essential Plan QHP	$262.85
Rate for Payer: Fidelis Medicare Advantage	$295.34
Rate for Payer: Fidelis Qualified Health Plan	$262.85
Rate for Payer: Group Health Inc Commercial	$295.34
Rate for Payer: Group Health Inc Medicare	$295.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.34
Rate for Payer: Hamaspik Choice Inc Medicare	$295.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$154.34
Rate for Payer: Healthfirst Medicare Advantage	$251.04
Rate for Payer: Healthfirst QHP	$295.34
Rate for Payer: Humana Medicare	$301.25
Rate for Payer: Senior Whole Health Medicare Advantage	$295.34
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$295.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$295.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$280.57
Rate for Payer: Wellcare Medicare	$280.57

HC TTE W/O DOPPLER COMPLETE - TTE COMPLETE NO DOPPLER NO COLOR

Facility

$705.00

Service Code	CPT 93307
Hospital Charge Code	4839330702
Hospital Revenue Code	483
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC TUBE THORACOSTOMY INCLUDES WATER SEAL

Facility

$4,940.00

Service Code	CPT 32551 TC
Hospital Charge Code	7613255101
Hospital Revenue Code	761
Min. Negotiated Rate	$181.02
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.02
Rate for Payer: Aetna Government	$181.02
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	$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	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.00

HC TUBE THORACOSTOMY INCLUDES WATER SEAL

Facility

$4,940.00

Service Code	CPT 32551 TC
Hospital Charge Code	7613255101
Hospital Revenue Code	761
Min. Negotiated Rate	$2,470.00
Max. Negotiated Rate	$2,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.00

HC TUBE THORACOSTOMY INCLUDES WATER SEAL

Facility

$4,940.00

Service Code	CPT 32551 TC
Hospital Charge Code	3613255101
Hospital Revenue Code	361
Min. Negotiated Rate	$181.02
Max. Negotiated Rate	$3,705.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$181.02
Rate for Payer: Aetna Government	$181.02
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	$2,470.00
Rate for Payer: United Healthcare Commercial	$1,188.00

HC TUBE THORACOSTOMY INCLUDES WATER SEAL

Facility

$4,940.00

Service Code	CPT 32551 TC
Hospital Charge Code	3613255101
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 TUMOR IMAGING (3D) - NM TUMOR LOCALIZATION SPECT

Facility

$3,853.00

Service Code	CPT 78803 TC
Hospital Charge Code	3417880301
Hospital Revenue Code	341
Min. Negotiated Rate	$1,926.50
Max. Negotiated Rate	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50

HC TUMOR IMAGING (3D) - NM TUMOR LOCALIZATION SPECT

Facility

$3,853.00

Service Code	CPT 78803 TC
Hospital Charge Code	3417880301
Hospital Revenue Code	341
Min. Negotiated Rate	$197.90
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.90
Rate for Payer: Aetna Government	$197.90
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,016.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$855.57
Rate for Payer: EmblemHealth Commercial	$303.35
Rate for Payer: Group Health Inc Commercial	$1,926.50
Rate for Payer: Group Health Inc Medicare	$1,348.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,926.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,926.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$303.35
Rate for Payer: Healthfirst Essential Plan	$510.91
Rate for Payer: United Healthcare Commercial	$379.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$227.07

HC TUMOR IMAGING, LIMITED AREA - NM TUMOR LOCALIZATION LIMITED

Facility

$1,114.00

Service Code	CPT 78800 TC
Hospital Charge Code	3417880001
Hospital Revenue Code	341
Min. Negotiated Rate	$108.32
Max. Negotiated Rate	$835.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$612.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.32
Rate for Payer: Aetna Government	$108.32
Rate for Payer: Brighton Health Commercial	$835.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$620.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$522.58
Rate for Payer: EmblemHealth Commercial	$207.99
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	$207.99
Rate for Payer: Healthfirst Essential Plan	$331.18
Rate for Payer: United Healthcare Commercial	$232.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$147.19

Know your out-of-pocket cost for care.

All Charges