St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC VISUAL FIELD EXAM,LMTD - AUTO VISUAL FIELD, SINGLE ISOPTER OD RT EYE

Facility

$166.00

Service Code	CPT 92081 TC
Hospital Charge Code	5109208101
Hospital Revenue Code	510
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.74
Rate for Payer: Aetna Government	$15.74
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	$83.00
Rate for Payer: Hamaspik Choice Inc Medicare	$83.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.80
Rate for Payer: United Healthcare Commercial	$222.00

HC VISUAL FIELD EXAM,LMTD - AUTO VISUAL FIELD, SINGLE ISOPTER OD RT EYE

Facility

$172.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208101
Hospital Revenue Code	920
Min. Negotiated Rate	$86.00
Max. Negotiated Rate	$86.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00

HC VISUAL FIELD EXAM,LMTD - AUTO VISUAL FIELD, SINGLE ISOPTER OD RT EYE

Facility

$166.00

Service Code	CPT 92081 TC
Hospital Charge Code	5109208101
Hospital Revenue Code	510
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$83.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00

HC VISUAL FIELD EXAM,LMTD - AUTO VISUAL FIELD, SINGLE ISOPTER OD RT EYE

Facility

$172.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208101
Hospital Revenue Code	920
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$137.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$94.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.74
Rate for Payer: Aetna Government	$15.74
Rate for Payer: Brighton Health Commercial	$129.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$116.96
Rate for Payer: EmblemHealth Commercial	$86.00
Rate for Payer: Group Health Inc Commercial	$86.00
Rate for Payer: Group Health Inc Medicare	$60.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.00
Rate for Payer: Hamaspik Choice Inc Medicare	$86.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.80
Rate for Payer: United Healthcare Commercial	$94.00

HC VISUAL FIELD EXAM,LMTD - PTOSIS VISUAL FIELD, LIMITED OD BOTH EYES

Facility

$174.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208106
Hospital Revenue Code	920
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$139.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.74
Rate for Payer: Aetna Government	$15.74
Rate for Payer: Brighton Health Commercial	$130.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.32
Rate for Payer: EmblemHealth Commercial	$87.00
Rate for Payer: Group Health Inc Commercial	$87.00
Rate for Payer: Group Health Inc Medicare	$60.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.80
Rate for Payer: United Healthcare Commercial	$94.00

HC VISUAL FIELD EXAM,LMTD - PTOSIS VISUAL FIELD, LIMITED OD BOTH EYES

Facility

$174.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208106
Hospital Revenue Code	920
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00

HC VISUAL FIELD EXAM,LMTD - PTOSIS VISUAL FIELD, LIMITED OD LT EYE

Facility

$174.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208105
Hospital Revenue Code	920
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00

HC VISUAL FIELD EXAM,LMTD - PTOSIS VISUAL FIELD, LIMITED OD LT EYE

Facility

$174.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208105
Hospital Revenue Code	920
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$139.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.74
Rate for Payer: Aetna Government	$15.74
Rate for Payer: Brighton Health Commercial	$130.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.32
Rate for Payer: EmblemHealth Commercial	$87.00
Rate for Payer: Group Health Inc Commercial	$87.00
Rate for Payer: Group Health Inc Medicare	$60.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.80
Rate for Payer: United Healthcare Commercial	$94.00

HC VISUAL FIELD EXAM,LMTD - PTOSIS VISUAL FIELD, LIMITED OD RT EYE

Facility

$174.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208104
Hospital Revenue Code	920
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$87.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00

HC VISUAL FIELD EXAM,LMTD - PTOSIS VISUAL FIELD, LIMITED OD RT EYE

Facility

$174.00

Service Code	CPT 92081 TC
Hospital Charge Code	9209208104
Hospital Revenue Code	920
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$139.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.74
Rate for Payer: Aetna Government	$15.74
Rate for Payer: Brighton Health Commercial	$130.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.32
Rate for Payer: EmblemHealth Commercial	$87.00
Rate for Payer: Group Health Inc Commercial	$87.00
Rate for Payer: Group Health Inc Medicare	$60.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.00
Rate for Payer: Hamaspik Choice Inc Medicare	$87.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.80
Rate for Payer: United Healthcare Commercial	$94.00

HC VISUAL SCREENING TEST, BILAT

Facility

$36.00

Service Code	CPT 99173 50
Hospital Charge Code	9209917301
Hospital Revenue Code	920
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.48
Rate for Payer: EmblemHealth Commercial	$18.00
Rate for Payer: Group Health Inc Commercial	$18.00
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00
Rate for Payer: United Healthcare Commercial	$94.00

HC VISUAL SCREENING TEST, BILAT

Facility

$36.00

Service Code	CPT 99173 50
Hospital Charge Code	9209917301
Hospital Revenue Code	920
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00

HC VITAL CAPACITY TEST - PR VITAL CAPACITY TEST

Facility

$419.00

Service Code	CPT 94150
Hospital Charge Code	4609415002
Hospital Revenue Code	460
Min. Negotiated Rate	$209.50
Max. Negotiated Rate	$209.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.50

HC VITAL CAPACITY TEST - PR VITAL CAPACITY TEST

Facility

$419.00

Service Code	CPT 94150
Hospital Charge Code	4609415002
Hospital Revenue Code	460
Min. Negotiated Rate	$133.82
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 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	$209.50
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 VITAMIN B-12 - VITAMIN B12

Facility

$37.00

Service Code	CPT 82607
Hospital Charge Code	3018260701
Hospital Revenue Code	301
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50

HC VITAMIN B-12 - VITAMIN B12

Facility

$37.00

Service Code	CPT 82607
Hospital Charge Code	3018260701
Hospital Revenue Code	301
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$28.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.08
Rate for Payer: Aetna Government	$15.08
Rate for Payer: Affinity Essential Plan 1&2	$10.56
Rate for Payer: Affinity Essential Plan 3&4	$10.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.56
Rate for Payer: Brighton Health Commercial	$27.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.57
Rate for Payer: Elderplan Medicare Advantage	$15.08
Rate for Payer: EmblemHealth Commercial	$15.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.57
Rate for Payer: Fidelis Essential Plan Aliesa	$12.82
Rate for Payer: Fidelis Essential Plan QHP	$13.42
Rate for Payer: Fidelis Medicare Advantage	$15.08
Rate for Payer: Fidelis Qualified Health Plan	$13.42
Rate for Payer: Group Health Inc Commercial	$15.08
Rate for Payer: Group Health Inc Medicare	$15.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.08
Rate for Payer: Hamaspik Choice Inc Medicare	$15.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.63
Rate for Payer: Healthfirst Essential Plan	$28.42
Rate for Payer: Healthfirst Medicare Advantage	$15.08
Rate for Payer: Healthfirst QHP	$15.08
Rate for Payer: Humana Medicare	$15.38
Rate for Payer: Senior Whole Health Medicare Advantage	$15.08
Rate for Payer: United Healthcare Commercial	$19.09
Rate for Payer: United Healthcare Medicare Advantage	$15.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.63
Rate for Payer: Wellcare Medicare	$13.57

HC VOLUME MEASUREMENT FOR TIMED COLLECTION, EACH

Facility

$236.00

Service Code	CPT 81050
Hospital Charge Code	3008105001
Hospital Revenue Code	300
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$118.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.00

HC VOLUME MEASUREMENT FOR TIMED COLLECTION, EACH

Facility

$236.00

Service Code	CPT 81050
Hospital Charge Code	3008105001
Hospital Revenue Code	300
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$177.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$129.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.64
Rate for Payer: Aetna Government	$3.64
Rate for Payer: Affinity Essential Plan 1&2	$2.55
Rate for Payer: Affinity Essential Plan 3&4	$2.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.55
Rate for Payer: Brighton Health Commercial	$177.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.28
Rate for Payer: Elderplan Medicare Advantage	$3.64
Rate for Payer: EmblemHealth Commercial	$3.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.28
Rate for Payer: Fidelis Essential Plan Aliesa	$3.09
Rate for Payer: Fidelis Essential Plan QHP	$3.24
Rate for Payer: Fidelis Medicare Advantage	$3.64
Rate for Payer: Fidelis Qualified Health Plan	$3.24
Rate for Payer: Group Health Inc Commercial	$3.64
Rate for Payer: Group Health Inc Medicare	$3.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.64
Rate for Payer: Hamaspik Choice Inc Medicare	$3.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.64
Rate for Payer: Healthfirst Medicare Advantage	$3.64
Rate for Payer: Healthfirst QHP	$3.64
Rate for Payer: Humana Medicare	$3.71
Rate for Payer: Senior Whole Health Medicare Advantage	$3.64
Rate for Payer: United Healthcare Commercial	$3.80
Rate for Payer: United Healthcare Medicare Advantage	$3.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.46
Rate for Payer: Wellcare Medicare	$3.28

HC VORICONAZOLE

Facility

$46.00

Service Code	CPT 80285
Hospital Charge Code	3018028501
Hospital Revenue Code	301
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$23.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00

HC VORICONAZOLE

Facility

$46.00

Service Code	CPT 80285
Hospital Charge Code	3018028501
Hospital Revenue Code	301
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$36.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.11
Rate for Payer: Aetna Government	$27.11
Rate for Payer: Affinity Essential Plan 1&2	$18.98
Rate for Payer: Affinity Essential Plan 3&4	$18.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.98
Rate for Payer: Brighton Health Commercial	$34.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.28
Rate for Payer: Elderplan Medicare Advantage	$27.11
Rate for Payer: EmblemHealth Commercial	$27.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24.40
Rate for Payer: Fidelis Essential Plan Aliesa	$23.04
Rate for Payer: Fidelis Essential Plan QHP	$24.13
Rate for Payer: Fidelis Medicare Advantage	$27.11
Rate for Payer: Fidelis Qualified Health Plan	$24.13
Rate for Payer: Group Health Inc Commercial	$27.11
Rate for Payer: Group Health Inc Medicare	$27.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.11
Rate for Payer: Hamaspik Choice Inc Medicare	$27.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.61
Rate for Payer: Healthfirst Essential Plan	$23.87
Rate for Payer: Healthfirst Medicare Advantage	$27.11
Rate for Payer: Healthfirst QHP	$27.11
Rate for Payer: Humana Medicare	$27.65
Rate for Payer: Senior Whole Health Medicare Advantage	$27.11
Rate for Payer: United Healthcare Commercial	$24.40
Rate for Payer: United Healthcare Medicare Advantage	$27.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.61
Rate for Payer: Wellcare Medicare	$24.40

HC VSP CUSTOMIZED BUNDLE

Facility

$9,961.00

Service Code	CPT 76376 TC
Hospital Charge Code	3507637603
Hospital Revenue Code	350
Min. Negotiated Rate	$4,980.50
Max. Negotiated Rate	$4,980.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,980.50

HC VSP CUSTOMIZED BUNDLE

Facility

$9,961.00

Service Code	CPT 76376 TC
Hospital Charge Code	3507637603
Hospital Revenue Code	350
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$7,968.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,478.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.96
Rate for Payer: Aetna Government	$13.96
Rate for Payer: Brighton Health Commercial	$7,470.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,968.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,773.48
Rate for Payer: EmblemHealth Commercial	$17.32
Rate for Payer: Group Health Inc Commercial	$4,980.50
Rate for Payer: Group Health Inc Medicare	$3,486.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,980.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,980.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17.32
Rate for Payer: Healthfirst Essential Plan	$104.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46.58

HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY

Facility

$37.00

Service Code	CPT 86021
Hospital Charge Code	3028602101
Hospital Revenue Code	302
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$27.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.05
Rate for Payer: Aetna Government	$15.05
Rate for Payer: Affinity Essential Plan 1&2	$10.54
Rate for Payer: Affinity Essential Plan 3&4	$10.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.54
Rate for Payer: Brighton Health Commercial	$27.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.53
Rate for Payer: Elderplan Medicare Advantage	$15.05
Rate for Payer: EmblemHealth Commercial	$15.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$13.54
Rate for Payer: Fidelis Essential Plan Aliesa	$12.79
Rate for Payer: Fidelis Essential Plan QHP	$13.39
Rate for Payer: Fidelis Medicare Advantage	$15.05
Rate for Payer: Fidelis Qualified Health Plan	$13.39
Rate for Payer: Group Health Inc Commercial	$15.05
Rate for Payer: Group Health Inc Medicare	$15.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.05
Rate for Payer: Hamaspik Choice Inc Medicare	$15.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.05
Rate for Payer: Healthfirst Medicare Advantage	$15.05
Rate for Payer: Healthfirst QHP	$15.05
Rate for Payer: Humana Medicare	$15.35
Rate for Payer: Senior Whole Health Medicare Advantage	$15.05
Rate for Payer: United Healthcare Commercial	$19.07
Rate for Payer: United Healthcare Medicare Advantage	$15.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.30
Rate for Payer: Wellcare Medicare	$13.54

HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY

Facility

$37.00

Service Code	CPT 86021
Hospital Charge Code	3028602101
Hospital Revenue Code	302
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.50

HC WEDGING OF CAST

Facility

$719.00

Service Code	CPT 29740
Hospital Charge Code	5102974001
Hospital Revenue Code	510
Min. Negotiated Rate	$359.50
Max. Negotiated Rate	$359.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.50

Know your out-of-pocket cost for care.

All Charges