St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEAD, URINE

Facility

$32.70

Hospital Charge Code	40609829
Hospital Revenue Code	301
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$26.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.35
Rate for Payer: Aetna Government	$16.35
Rate for Payer: Brighton Health Commercial	$24.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.24
Rate for Payer: Group Health Inc Commercial	$16.35
Rate for Payer: Group Health Inc Medicare	$11.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.35
Rate for Payer: Hamaspik Choice Inc Medicare	$16.35

LEAD, VENTRICULAR

Facility

$1,650.00

Service Code	HCPCS C1900
Hospital Charge Code	40203573
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00

LEAD, VENTRICULAR

Facility

$1,650.00

Service Code	HCPCS C1900
Hospital Charge Code	40203573
Hospital Revenue Code	278
Min. Negotiated Rate	$98.84
Max. Negotiated Rate	$1,732.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$907.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.84
Rate for Payer: Aetna Government	$98.84
Rate for Payer: Brighton Health Commercial	$990.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$825.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$948.75
Rate for Payer: EmblemHealth Commercial	$825.00
Rate for Payer: Fidelis Medicare Advantage	$1,732.50
Rate for Payer: Group Health Inc Commercial	$825.00
Rate for Payer: Group Health Inc Medicare	$577.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$825.00
Rate for Payer: Hamaspik Choice Inc Medicare	$825.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,072.50

LEARN DISABILITY EVAL

Facility

$318.94

Hospital Charge Code	41904854
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$159.47
Rate for Payer: Aetna Government	$159.47
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$159.47
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.47
Rate for Payer: Hamaspik Choice Inc Medicare	$159.47
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

LEARN DISABILITY GRP 46-60 MIN.

Facility

$127.58

Hospital Charge Code	41904862
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.79
Rate for Payer: Aetna Government	$63.79
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$63.79
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.79
Rate for Payer: Hamaspik Choice Inc Medicare	$63.79
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

LEARN DISABL. THERAPY 15-30 MIN.

Facility

$129.63

Hospital Charge Code	41904860
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64.82
Rate for Payer: Aetna Government	$64.82
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$64.82
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.82
Rate for Payer: Hamaspik Choice Inc Medicare	$64.82
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

LEARN DIS/READ THPY IND 31-45 MIN

Facility

$191.36

Hospital Charge Code	41904861
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.68
Rate for Payer: Aetna Government	$95.68
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$95.68
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.68
Rate for Payer: Hamaspik Choice Inc Medicare	$95.68
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

LEARN DIS/READ THPY IND 46-60 MIN

Facility

$212.63

Hospital Charge Code	41904863
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$106.32
Rate for Payer: Aetna Government	$106.32
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$106.32
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.32
Rate for Payer: Hamaspik Choice Inc Medicare	$106.32
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

LEB ANTIGEN

Facility

$858.38

Service Code	HCPCS 86905
Hospital Charge Code	40701265
Hospital Revenue Code	300
Rate for Payer: Cash Price	$415.67

LEB ANTIGEN

Facility

$858.38

Service Code	HCPCS 86905
Hospital Charge Code	40701265
Hospital Revenue Code	300
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$643.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$472.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$415.67
Rate for Payer: Aetna Government	$415.67
Rate for Payer: Affinity Essential Plan 1&2	$290.97
Rate for Payer: Affinity Essential Plan 3&4	$290.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$290.97
Rate for Payer: Brighton Health Commercial	$643.78
Rate for Payer: Cash Price	$415.67
Rate for Payer: Cash Price	$415.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$415.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.15
Rate for Payer: Elderplan Medicare Advantage	$415.67
Rate for Payer: EmblemHealth Commercial	$415.67
Rate for Payer: Fidelis Essential Plan Aliesa	$353.32
Rate for Payer: Fidelis Essential Plan QHP	$369.95
Rate for Payer: Fidelis Medicare Advantage	$415.67
Rate for Payer: Fidelis Qualified Health Plan	$369.95
Rate for Payer: Group Health Inc Commercial	$415.67
Rate for Payer: Group Health Inc Medicare	$415.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$429.19
Rate for Payer: Hamaspik Choice Inc Medicare	$415.67
Rate for Payer: Healthfirst Medicare Advantage	$415.67
Rate for Payer: Healthfirst QHP	$415.67
Rate for Payer: Humana Medicare	$423.98
Rate for Payer: Senior Whole Health Medicare Advantage	$415.67
Rate for Payer: United Healthcare Commercial	$4.84
Rate for Payer: United Healthcare Medicare Advantage	$415.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$415.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$332.54
Rate for Payer: Wellcare Medicare	$374.10

LEE AND WHITE CLOTTING TIME

Facility

$34.38

Hospital Charge Code	42904320
Hospital Revenue Code	801
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$27.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.19
Rate for Payer: Aetna Government	$17.19
Rate for Payer: Brighton Health Commercial	$25.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.38
Rate for Payer: Group Health Inc Commercial	$17.19
Rate for Payer: Group Health Inc Medicare	$12.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.19
Rate for Payer: Hamaspik Choice Inc Medicare	$17.19

LEFORT II OR III (OSTEO-FACIAL BO

Facility

$7,250.00

Service Code	HCPCS D7948
Hospital Charge Code	42302100
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$5,437.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,987.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,327.48
Rate for Payer: Aetna Government	$3,327.48
Rate for Payer: Brighton Health Commercial	$5,437.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$3,625.00
Rate for Payer: Group Health Inc Medicare	$2,537.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,625.00

LEFORT II OR LEFORT III WITH BONE

Facility

$8,700.00

Service Code	HCPCS D7949
Hospital Charge Code	42302105
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$6,525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,785.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,333.92
Rate for Payer: Aetna Government	$4,333.92
Rate for Payer: Brighton Health Commercial	$6,525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$4,350.00
Rate for Payer: Group Health Inc Medicare	$3,045.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,350.00

LEFORT I MAXILLA-SEGMENTED

Facility

$7,250.00

Service Code	HCPCS D7947
Hospital Charge Code	42302095
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$5,437.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,987.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,563.69
Rate for Payer: Aetna Government	$2,563.69
Rate for Payer: Brighton Health Commercial	$5,437.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$3,625.00
Rate for Payer: Group Health Inc Medicare	$2,537.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,625.00

LEFORT I MAXILLA-TOTAL

Facility

$5,437.50

Service Code	HCPCS D7946
Hospital Charge Code	42302090
Hospital Revenue Code	361
Min. Negotiated Rate	$1,903.12
Max. Negotiated Rate	$4,078.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,990.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,048.52
Rate for Payer: Aetna Government	$3,048.52
Rate for Payer: Brighton Health Commercial	$4,078.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$2,718.75
Rate for Payer: Group Health Inc Medicare	$1,903.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,718.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,718.75

LEFT ANGLE LANINA HOOK

Facility

$1,856.00

Hospital Charge Code	40200835
Hospital Revenue Code	270
Min. Negotiated Rate	$649.60
Max. Negotiated Rate	$1,484.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,020.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$928.00
Rate for Payer: Aetna Government	$928.00
Rate for Payer: Brighton Health Commercial	$1,392.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,484.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,262.08
Rate for Payer: Group Health Inc Commercial	$928.00
Rate for Payer: Group Health Inc Medicare	$649.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$928.00
Rate for Payer: Hamaspik Choice Inc Medicare	$928.00

LEFT HORSESHOE GEL PAD

Facility

$867.50

Hospital Charge Code	64905097
Hospital Revenue Code	270
Min. Negotiated Rate	$303.62
Max. Negotiated Rate	$694.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$477.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$433.75
Rate for Payer: Aetna Government	$433.75
Rate for Payer: Brighton Health Commercial	$650.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$694.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$589.90
Rate for Payer: Group Health Inc Commercial	$433.75
Rate for Payer: Group Health Inc Medicare	$303.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$433.75
Rate for Payer: Hamaspik Choice Inc Medicare	$433.75

LEFT POPLITEPL FORCEP

Facility

$599.75

Hospital Charge Code	64903646
Hospital Revenue Code	270
Min. Negotiated Rate	$209.91
Max. Negotiated Rate	$479.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$329.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$299.88
Rate for Payer: Aetna Government	$299.88
Rate for Payer: Brighton Health Commercial	$449.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$479.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$407.83
Rate for Payer: Group Health Inc Commercial	$299.88
Rate for Payer: Group Health Inc Medicare	$209.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$299.88
Rate for Payer: Hamaspik Choice Inc Medicare	$299.88

LEGEND 9CM 7.5MM ACORN

Facility

$407.50

Hospital Charge Code	64905286
Hospital Revenue Code	270
Min. Negotiated Rate	$142.62
Max. Negotiated Rate	$326.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.75
Rate for Payer: Aetna Government	$203.75
Rate for Payer: Brighton Health Commercial	$305.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$326.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.10
Rate for Payer: Group Health Inc Commercial	$203.75
Rate for Payer: Group Health Inc Medicare	$142.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.75
Rate for Payer: Hamaspik Choice Inc Medicare	$203.75

LEGION CON ART INS 9MM SZ 1-2

Facility

$4,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64905247
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,935.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,585.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,820.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,702.50
Rate for Payer: EmblemHealth Commercial	$2,350.00
Rate for Payer: Fidelis Medicare Advantage	$4,935.00
Rate for Payer: Group Health Inc Commercial	$2,350.00
Rate for Payer: Group Health Inc Medicare	$1,645.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,055.00

LEGION CON ART INS 9MM SZ 1-2

Facility

$4,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64905247
Hospital Revenue Code	278
Min. Negotiated Rate	$2,350.00
Max. Negotiated Rate	$2,350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,350.00

LEGIONELLA PNEUM AB IGM, IFA

Facility

$38.25

Service Code	HCPCS 86713
Hospital Charge Code	40728051
Hospital Revenue Code	302
Rate for Payer: Cash Price	$15.30

LEGIONELLA PNEUM AB IGM, IFA

Facility

$38.25

Service Code	HCPCS 86713
Hospital Charge Code	40728051
Hospital Revenue Code	302
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$28.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.30
Rate for Payer: Aetna Government	$15.30
Rate for Payer: Affinity Essential Plan 1&2	$10.71
Rate for Payer: Affinity Essential Plan 3&4	$10.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.71
Rate for Payer: Brighton Health Commercial	$28.69
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.57
Rate for Payer: Elderplan Medicare Advantage	$15.30
Rate for Payer: EmblemHealth Commercial	$15.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.00
Rate for Payer: Fidelis Essential Plan QHP	$13.62
Rate for Payer: Fidelis Medicare Advantage	$15.30
Rate for Payer: Fidelis Qualified Health Plan	$13.62
Rate for Payer: Group Health Inc Commercial	$15.30
Rate for Payer: Group Health Inc Medicare	$15.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.12
Rate for Payer: Hamaspik Choice Inc Medicare	$15.30
Rate for Payer: Healthfirst Medicare Advantage	$15.30
Rate for Payer: Healthfirst QHP	$15.30
Rate for Payer: Humana Medicare	$15.61
Rate for Payer: Senior Whole Health Medicare Advantage	$15.30
Rate for Payer: United Healthcare Commercial	$19.38
Rate for Payer: United Healthcare Medicare Advantage	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.24
Rate for Payer: Wellcare Medicare	$13.77

LEGIONELLA PNEUMOPHILA 1-6,IGM

Facility

$38.25

Service Code	HCPCS 86713
Hospital Charge Code	40619173
Hospital Revenue Code	300
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$28.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.30
Rate for Payer: Aetna Government	$15.30
Rate for Payer: Affinity Essential Plan 1&2	$10.71
Rate for Payer: Affinity Essential Plan 3&4	$10.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.71
Rate for Payer: Brighton Health Commercial	$28.69
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.57
Rate for Payer: Elderplan Medicare Advantage	$15.30
Rate for Payer: EmblemHealth Commercial	$15.30
Rate for Payer: Fidelis Essential Plan Aliesa	$13.00
Rate for Payer: Fidelis Essential Plan QHP	$13.62
Rate for Payer: Fidelis Medicare Advantage	$15.30
Rate for Payer: Fidelis Qualified Health Plan	$13.62
Rate for Payer: Group Health Inc Commercial	$15.30
Rate for Payer: Group Health Inc Medicare	$15.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.12
Rate for Payer: Hamaspik Choice Inc Medicare	$15.30
Rate for Payer: Healthfirst Medicare Advantage	$15.30
Rate for Payer: Healthfirst QHP	$15.30
Rate for Payer: Humana Medicare	$15.61
Rate for Payer: Senior Whole Health Medicare Advantage	$15.30
Rate for Payer: United Healthcare Commercial	$19.38
Rate for Payer: United Healthcare Medicare Advantage	$15.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.24
Rate for Payer: Wellcare Medicare	$13.77

LEGIONELLA PNEUMOPHILA 1-6,IGM

Facility

$38.25

Service Code	HCPCS 86713
Hospital Charge Code	40619173
Hospital Revenue Code	300
Rate for Payer: Cash Price	$15.30

Know your out-of-pocket cost for care.

All Charges