St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$557.00
Max. Negotiated Rate	$557.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$557.00

HC TUMOR IMAGING, MULT AREAS - NM TUMOR LOCALIZATION MULTIPLE AREAS

Facility

$1,360.00

Service Code	CPT 78801 TC
Hospital Charge Code	3417880102
Hospital Revenue Code	341
Min. Negotiated Rate	$151.64
Max. Negotiated Rate	$1,020.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$748.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$151.64
Rate for Payer: Aetna Government	$151.64
Rate for Payer: Brighton Health Commercial	$1,020.00
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	$221.62
Rate for Payer: Group Health Inc Commercial	$680.00
Rate for Payer: Group Health Inc Medicare	$476.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$680.00
Rate for Payer: Hamaspik Choice Inc Medicare	$680.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$221.62
Rate for Payer: Healthfirst Essential Plan	$367.54
Rate for Payer: United Healthcare Commercial	$379.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.35

HC TUMOR IMAGING, MULT AREAS - NM TUMOR LOCALIZATION MULTIPLE AREAS

Facility

$1,360.00

Service Code	CPT 78801 TC
Hospital Charge Code	3417880102
Hospital Revenue Code	341
Min. Negotiated Rate	$680.00
Max. Negotiated Rate	$680.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$680.00

HC TUMOR IMAGING, MULT AREAS - NM TUMOR OCTREOSCAN

Facility

$1,360.00

Service Code	CPT 78801 TC
Hospital Charge Code	3417880101
Hospital Revenue Code	341
Min. Negotiated Rate	$680.00
Max. Negotiated Rate	$680.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$680.00

HC TUMOR IMAGING, MULT AREAS - NM TUMOR OCTREOSCAN

Facility

$1,360.00

Service Code	CPT 78801 TC
Hospital Charge Code	3417880101
Hospital Revenue Code	341
Min. Negotiated Rate	$151.64
Max. Negotiated Rate	$1,020.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$748.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$151.64
Rate for Payer: Aetna Government	$151.64
Rate for Payer: Brighton Health Commercial	$1,020.00
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	$221.62
Rate for Payer: Group Health Inc Commercial	$680.00
Rate for Payer: Group Health Inc Medicare	$476.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$680.00
Rate for Payer: Hamaspik Choice Inc Medicare	$680.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$221.62
Rate for Payer: Healthfirst Essential Plan	$367.54
Rate for Payer: United Healthcare Commercial	$379.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.35

HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCALIZATION WHOLE BODY

Facility

$3,853.00

Service Code	CPT 78802 TC
Hospital Charge Code	3417880203
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 WHOLE BODY - NM TUMOR LOCALIZATION WHOLE BODY

Facility

$3,853.00

Service Code	CPT 78802 TC
Hospital Charge Code	3417880203
Hospital Revenue Code	341
Min. Negotiated Rate	$194.39
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$194.39
Rate for Payer: Aetna Government	$194.39
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	$250.60
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	$250.60
Rate for Payer: Healthfirst Essential Plan	$475.79
Rate for Payer: United Healthcare Commercial	$379.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$211.46

HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCAL WHOLE BODY MULT DAYS

Facility

$3,853.00

Service Code	CPT 78804 TC
Hospital Charge Code	3417880401
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 WHOLE BODY - NM TUMOR LOCAL WHOLE BODY MULT DAYS

Facility

$3,853.00

Service Code	CPT 78804 TC
Hospital Charge Code	3417880401
Hospital Revenue Code	341
Min. Negotiated Rate	$353.29
Max. Negotiated Rate	$2,889.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,119.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$353.29
Rate for Payer: Aetna Government	$353.29
Rate for Payer: Brighton Health Commercial	$2,889.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,766.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,486.57
Rate for Payer: EmblemHealth Commercial	$550.48
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	$550.48
Rate for Payer: Healthfirst Essential Plan	$1,002.22
Rate for Payer: United Healthcare Commercial	$660.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$445.43

HC TUMOR IMMUNOHISTOCHEMISTRY - MANUAL

Facility

$434.00

Service Code	CPT 88360 TC
Hospital Charge Code	3128836001
Hospital Revenue Code	312
Min. Negotiated Rate	$25.62
Max. Negotiated Rate	$325.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.60
Rate for Payer: Aetna Government	$41.60
Rate for Payer: Brighton Health Commercial	$325.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$72.19
Rate for Payer: EmblemHealth Commercial	$92.22
Rate for Payer: Group Health Inc Commercial	$217.00
Rate for Payer: Group Health Inc Medicare	$151.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.00
Rate for Payer: Hamaspik Choice Inc Medicare	$217.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.62
Rate for Payer: Healthfirst Essential Plan	$57.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25.62

HC TUMOR IMMUNOHISTOCHEMISTRY - MANUAL

Facility

$434.00

Service Code	CPT 88360 TC
Hospital Charge Code	3128836001
Hospital Revenue Code	312
Min. Negotiated Rate	$217.00
Max. Negotiated Rate	$217.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.00

HC TX CARPOMETACARPAL DISLOCATION, W/ANES

Facility

$4,105.00

Service Code	CPT 26675
Hospital Charge Code	3612667501
Hospital Revenue Code	361
Min. Negotiated Rate	$516.76
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
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	$516.76
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	$1,113.00
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 TX CARPOMETACARPAL DISLOCATION, W/ANES

Facility

$4,105.00

Service Code	CPT 26675
Hospital Charge Code	3612667501
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 TX CARPOMETACARPAL DISLOCATION, W/O ANES

Facility

$653.00

Service Code	CPT 26670
Hospital Charge Code	3612667001
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
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	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$388.83
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

HC TX CARPOMETACARPAL DISLOCATION, W/O ANES

Facility

$653.00

Service Code	CPT 26670
Hospital Charge Code	3612667001
Hospital Revenue Code	361
Min. Negotiated Rate	$326.50
Max. Negotiated Rate	$326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$326.50

HC TX MAND/MAX ALVEOLAR RIDGE FRAC

Facility

$7,933.00

Service Code	CPT 21440
Hospital Charge Code	3612144001
Hospital Revenue Code	361
Min. Negotiated Rate	$3,966.50
Max. Negotiated Rate	$3,966.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,966.50

HC TX MAND/MAX ALVEOLAR RIDGE FRAC

Facility

$7,933.00

Service Code	CPT 21440
Hospital Charge Code	3612144001
Hospital Revenue Code	361
Min. Negotiated Rate	$602.62
Max. Negotiated Rate	$5,949.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,962.45
Rate for Payer: Aetna Government	$3,962.45
Rate for Payer: Affinity Essential Plan 1&2	$2,773.72
Rate for Payer: Affinity Essential Plan 3&4	$2,773.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,773.72
Rate for Payer: Brighton Health Commercial	$5,949.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,962.45
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	$3,962.45
Rate for Payer: EmblemHealth Commercial	$3,962.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,566.20
Rate for Payer: Fidelis Essential Plan Aliesa	$3,368.08
Rate for Payer: Fidelis Essential Plan QHP	$3,526.58
Rate for Payer: Fidelis Medicare Advantage	$3,962.45
Rate for Payer: Fidelis Qualified Health Plan	$3,526.58
Rate for Payer: Group Health Inc Commercial	$3,962.45
Rate for Payer: Group Health Inc Medicare	$3,962.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,962.45
Rate for Payer: Hamaspik Choice Inc Medicare	$602.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$690.78
Rate for Payer: Healthfirst Medicare Advantage	$3,368.08
Rate for Payer: Healthfirst QHP	$3,962.45
Rate for Payer: Humana Medicare	$4,041.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,962.45
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,962.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,764.33
Rate for Payer: Wellcare Medicare	$3,764.33

HC TYMPANOMETRY

Facility

$101.00

Service Code	CPT 92567
Hospital Charge Code	4719256701
Hospital Revenue Code	471
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$50.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.50

HC TYMPANOMETRY

Facility

$101.00

Service Code	CPT 92567
Hospital Charge Code	4719256701
Hospital Revenue Code	471
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$158.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.96
Rate for Payer: Aetna Government	$47.96
Rate for Payer: Affinity Essential Plan 1&2	$33.57
Rate for Payer: Affinity Essential Plan 3&4	$33.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$33.57
Rate for Payer: Brighton Health Commercial	$75.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47.96
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	$47.96
Rate for Payer: EmblemHealth Commercial	$47.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43.16
Rate for Payer: Fidelis Essential Plan Aliesa	$40.77
Rate for Payer: Fidelis Essential Plan QHP	$42.68
Rate for Payer: Fidelis Medicare Advantage	$47.96
Rate for Payer: Fidelis Qualified Health Plan	$42.68
Rate for Payer: Group Health Inc Commercial	$47.96
Rate for Payer: Group Health Inc Medicare	$47.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.96
Rate for Payer: Hamaspik Choice Inc Medicare	$47.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.78
Rate for Payer: Healthfirst Medicare Advantage	$40.77
Rate for Payer: Healthfirst QHP	$47.96
Rate for Payer: Humana Medicare	$48.92
Rate for Payer: Senior Whole Health Medicare Advantage	$47.96
Rate for Payer: United Healthcare Commercial	$158.00
Rate for Payer: United Healthcare Medicare Advantage	$47.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45.56
Rate for Payer: Wellcare Medicare	$45.56

HC TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS

Facility

$419.00

Service Code	CPT 92550
Hospital Charge Code	4719255001
Hospital Revenue Code	471
Min. Negotiated Rate	$23.93
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	$23.93
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 TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS

Facility

$419.00

Service Code	CPT 92550
Hospital Charge Code	4719255001
Hospital Revenue Code	471
Min. Negotiated Rate	$209.50
Max. Negotiated Rate	$209.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50

HC TYPHOID VACCINE, IM

Facility

$536.00

Service Code	CPT 90691
Hospital Charge Code	6369069101
Hospital Revenue Code	636
Min. Negotiated Rate	$268.00
Max. Negotiated Rate	$268.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$268.00
Rate for Payer: Hamaspik Choice Inc Medicare	$268.00

HC TYPHOID VACCINE, IM

Facility

$536.00

Service Code	CPT 90691
Hospital Charge Code	6369069101
Hospital Revenue Code	636
Min. Negotiated Rate	$77.85
Max. Negotiated Rate	$348.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.85
Rate for Payer: Aetna Government	$77.85
Rate for Payer: Brighton Health Commercial	$321.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.20
Rate for Payer: EmblemHealth Commercial	$268.00
Rate for Payer: Group Health Inc Commercial	$268.00
Rate for Payer: Group Health Inc Medicare	$187.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$268.00
Rate for Payer: Hamaspik Choice Inc Medicare	$268.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$348.40

HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US INTRAOPERATIVE

Facility

$348.00

Service Code	CPT 76998 TC
Hospital Charge Code	4027699802
Hospital Revenue Code	402
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$174.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.00

HC ULTRASONIC GUIDANCE, INTRAOPERATIVE - US INTRAOPERATIVE

Facility

$348.00

Service Code	CPT 76998 TC
Hospital Charge Code	4027699802
Hospital Revenue Code	402
Min. Negotiated Rate	$50.29
Max. Negotiated Rate	$278.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.29
Rate for Payer: Aetna Government	$50.29
Rate for Payer: Brighton Health Commercial	$261.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$278.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.64
Rate for Payer: EmblemHealth Commercial	$174.00
Rate for Payer: Group Health Inc Commercial	$174.00
Rate for Payer: Group Health Inc Medicare	$121.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.00
Rate for Payer: Hamaspik Choice Inc Medicare	$174.00
Rate for Payer: Healthfirst Essential Plan	$249.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$110.94

Know your out-of-pocket cost for care.

All Charges