St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LYSIS PENIL CIRCUMCISION LESION

Facility

$5,365.58

Service Code	HCPCS 54162
Hospital Charge Code	40124371
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,355.42

LYSIS PENIL CIRCUMCISION LESION

Facility

$5,365.58

Service Code	HCPCS 54162
Hospital Charge Code	40124371
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$4,024.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,355.42
Rate for Payer: Aetna Government	$2,355.42
Rate for Payer: Affinity Essential Plan 1&2	$1,648.79
Rate for Payer: Affinity Essential Plan 3&4	$1,648.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,648.79
Rate for Payer: Brighton Health Commercial	$4,024.18
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,355.42
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: Elderplan Medicare Advantage	$2,355.42
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,002.11
Rate for Payer: Fidelis Essential Plan QHP	$2,096.32
Rate for Payer: Fidelis Medicare Advantage	$2,355.42
Rate for Payer: Fidelis Qualified Health Plan	$2,096.32
Rate for Payer: Group Health Inc Commercial	$2,355.42
Rate for Payer: Group Health Inc Medicare	$2,355.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,355.42
Rate for Payer: Healthfirst Medicare Advantage	$2,002.11
Rate for Payer: Healthfirst QHP	$2,355.42
Rate for Payer: Humana Medicare	$2,402.53
Rate for Payer: Senior Whole Health Medicare Advantage	$2,355.42
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$2,355.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,355.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,884.34
Rate for Payer: Wellcare Medicare	$2,237.65

LYSOZYME SERUM

Facility

$46.88

Service Code	HCPCS 85549
Hospital Charge Code	40609729
Hospital Revenue Code	305
Rate for Payer: Cash Price	$18.75

LYSOZYME SERUM

Facility

$46.88

Service Code	HCPCS 85549
Hospital Charge Code	40609729
Hospital Revenue Code	305
Min. Negotiated Rate	$13.12
Max. Negotiated Rate	$35.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.75
Rate for Payer: Aetna Government	$18.75
Rate for Payer: Affinity Essential Plan 1&2	$13.12
Rate for Payer: Affinity Essential Plan 3&4	$13.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.12
Rate for Payer: Brighton Health Commercial	$35.16
Rate for Payer: Cash Price	$18.75
Rate for Payer: Cash Price	$18.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.23
Rate for Payer: Elderplan Medicare Advantage	$18.75
Rate for Payer: EmblemHealth Commercial	$18.75
Rate for Payer: Fidelis Essential Plan Aliesa	$15.94
Rate for Payer: Fidelis Essential Plan QHP	$16.69
Rate for Payer: Fidelis Medicare Advantage	$18.75
Rate for Payer: Fidelis Qualified Health Plan	$16.69
Rate for Payer: Group Health Inc Commercial	$18.75
Rate for Payer: Group Health Inc Medicare	$18.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.44
Rate for Payer: Hamaspik Choice Inc Medicare	$18.75
Rate for Payer: Healthfirst Medicare Advantage	$18.75
Rate for Payer: Healthfirst QHP	$18.75
Rate for Payer: Humana Medicare	$19.12
Rate for Payer: Senior Whole Health Medicare Advantage	$18.75
Rate for Payer: United Healthcare Commercial	$23.76
Rate for Payer: United Healthcare Medicare Advantage	$18.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.00
Rate for Payer: Wellcare Medicare	$16.88

M001-IGE PENICILLIUM CHRYSOGEN

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729263
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M001-IGE PENICILLIUM CHRYSOGEN

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729263
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M003-IGE ASPERGILLUS FUMIGATUS

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729257
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M003-IGE ASPERGILLUS FUMIGATUS

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729257
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M004-IGE MUCOR RACEMOSUS

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729294
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M004-IGE MUCOR RACEMOSUS

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729294
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M005-IGE CANDIDA ALBICANS

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729288
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M005-IGE CANDIDA ALBICANS

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729288
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M006-IGE ALTERNARIA ALTERNATA

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729245
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M006-IGE ALTERNARIA ALTERNATA

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729245
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M008-IGE SETOMELANOMMA ROSTRAT

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729298
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M008-IGE SETOMELANOMMA ROSTRAT

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729298
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M009-IGE FUSARIUM PROLIFERATUM

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729297
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M009-IGE FUSARIUM PROLIFERATUM

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729297
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M014-IGE EPICOCCUM PURPUR

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729296
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$9.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Affinity Essential Plan 1&2	$3.65
Rate for Payer: Affinity Essential Plan 3&4	$3.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.65
Rate for Payer: Brighton Health Commercial	$9.79
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cash Price	$5.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$5.22
Rate for Payer: Fidelis Essential Plan Aliesa	$4.44
Rate for Payer: Fidelis Essential Plan QHP	$4.65
Rate for Payer: Fidelis Medicare Advantage	$5.22
Rate for Payer: Fidelis Qualified Health Plan	$4.65
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$5.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.52
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: Healthfirst Medicare Advantage	$5.22
Rate for Payer: Healthfirst QHP	$5.22
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Senior Whole Health Medicare Advantage	$5.22
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.18
Rate for Payer: Wellcare Medicare	$4.70

M014-IGE EPICOCCUM PURPUR

Facility

$13.05

Service Code	HCPCS 86003
Hospital Charge Code	40729296
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.22

M207-IGG ASPERGILLUS NIGER

Facility

$19.55

Service Code	HCPCS 86001
Hospital Charge Code	40729244
Hospital Revenue Code	300
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$14.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.82
Rate for Payer: Aetna Government	$7.82
Rate for Payer: Affinity Essential Plan 1&2	$5.47
Rate for Payer: Affinity Essential Plan 3&4	$5.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.47
Rate for Payer: Brighton Health Commercial	$14.66
Rate for Payer: Cash Price	$7.82
Rate for Payer: Cash Price	$7.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.01
Rate for Payer: Elderplan Medicare Advantage	$7.82
Rate for Payer: EmblemHealth Commercial	$7.82
Rate for Payer: Fidelis Essential Plan Aliesa	$6.65
Rate for Payer: Fidelis Essential Plan QHP	$6.96
Rate for Payer: Fidelis Medicare Advantage	$7.82
Rate for Payer: Fidelis Qualified Health Plan	$6.96
Rate for Payer: Group Health Inc Commercial	$7.82
Rate for Payer: Group Health Inc Medicare	$7.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.78
Rate for Payer: Hamaspik Choice Inc Medicare	$7.82
Rate for Payer: Healthfirst Medicare Advantage	$7.82
Rate for Payer: Healthfirst QHP	$7.82
Rate for Payer: Humana Medicare	$7.98
Rate for Payer: Senior Whole Health Medicare Advantage	$7.82
Rate for Payer: United Healthcare Commercial	$6.61
Rate for Payer: United Healthcare Medicare Advantage	$7.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.26
Rate for Payer: Wellcare Medicare	$7.04

M207-IGG ASPERGILLUS NIGER

Facility

$19.55

Service Code	HCPCS 86001
Hospital Charge Code	40729244
Hospital Revenue Code	300
Rate for Payer: Cash Price	$7.82

M2A MAGNUM CUP 48MM X 42

Facility

$9,757.50

Hospital Charge Code	64904100
Hospital Revenue Code	270
Min. Negotiated Rate	$3,415.12
Max. Negotiated Rate	$7,806.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,366.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,878.75
Rate for Payer: Aetna Government	$4,878.75
Rate for Payer: Brighton Health Commercial	$7,318.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,806.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,635.10
Rate for Payer: Group Health Inc Commercial	$4,878.75
Rate for Payer: Group Health Inc Medicare	$3,415.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,878.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,878.75

M2A MAGNUM (TM) PF CUP

Facility

$9,825.00

Hospital Charge Code	64903193
Hospital Revenue Code	270
Min. Negotiated Rate	$3,438.75
Max. Negotiated Rate	$7,860.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,403.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,912.50
Rate for Payer: Aetna Government	$4,912.50
Rate for Payer: Brighton Health Commercial	$7,368.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,860.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,681.00
Rate for Payer: Group Health Inc Commercial	$4,912.50
Rate for Payer: Group Health Inc Medicare	$3,438.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,912.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,912.50

MA BREAST SPECIMEN

Facility

$1,458.58

Service Code	HCPCS 76098 TC
Hospital Charge Code	41102660
Hospital Revenue Code	320
Rate for Payer: Cash Price	$637.97

Know your out-of-pocket cost for care.

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