St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OPH US DX B-SCAN

Facility

$339.45

Service Code	HCPCS 76512 TC
Hospital Charge Code	41109825
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

OPH US DX B-SCAN

Facility

$339.45

Service Code	HCPCS 76512 TC
Hospital Charge Code	41105907
Hospital Revenue Code	402
Rate for Payer: Cash Price	$127.14

OPH US DX B-SCAN

Facility

$339.45

Service Code	HCPCS 76512 TC
Hospital Charge Code	41109825
Hospital Revenue Code	402
Min. Negotiated Rate	$77.02
Max. Negotiated Rate	$192.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.05
Rate for Payer: Elderplan Medicare Advantage	$127.14
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108.07
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$114.43
Rate for Payer: Group Health Inc Medicare	$114.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.43
Rate for Payer: Healthfirst Medicare Advantage	$127.14
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

OPH US DX B-SCAN

Facility

$339.45

Service Code	HCPCS 76512 TC
Hospital Charge Code	41105907
Hospital Revenue Code	402
Min. Negotiated Rate	$77.02
Max. Negotiated Rate	$192.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.05
Rate for Payer: Elderplan Medicare Advantage	$127.14
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108.07
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$114.43
Rate for Payer: Group Health Inc Medicare	$114.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$114.43
Rate for Payer: Healthfirst Medicare Advantage	$127.14
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

OPIATE CONFIRMATION, URINE

Facility

$49.93

Service Code	HCPCS 80361
Hospital Charge Code	40609022
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.95
Rate for Payer: Group Health Inc Commercial	$24.96
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.96
Rate for Payer: Hamaspik Choice Inc Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$31.48

OPSCPY EXTEND ON/MAC DRAW

Facility

$166.60

Service Code	HCPCS 92202
Hospital Charge Code	42102002
Hospital Revenue Code	920
Rate for Payer: Cash Price	$70.74

OPSCPY EXTEND ON/MAC DRAW

Facility

$166.60

Service Code	HCPCS 92202
Hospital Charge Code	42102002
Hospital Revenue Code	920
Min. Negotiated Rate	$49.52
Max. Negotiated Rate	$133.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.74
Rate for Payer: Aetna Government	$70.74
Rate for Payer: Affinity Essential Plan 1&2	$49.52
Rate for Payer: Affinity Essential Plan 3&4	$49.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.52
Rate for Payer: Brighton Health Commercial	$124.95
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.29
Rate for Payer: Elderplan Medicare Advantage	$70.74
Rate for Payer: EmblemHealth Commercial	$70.74
Rate for Payer: Fidelis Essential Plan Aliesa	$60.13
Rate for Payer: Fidelis Essential Plan QHP	$62.96
Rate for Payer: Fidelis Medicare Advantage	$70.74
Rate for Payer: Fidelis Qualified Health Plan	$62.96
Rate for Payer: Group Health Inc Commercial	$70.74
Rate for Payer: Group Health Inc Medicare	$70.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.30
Rate for Payer: Hamaspik Choice Inc Medicare	$70.74
Rate for Payer: Healthfirst Medicare Advantage	$60.13
Rate for Payer: Healthfirst QHP	$70.74
Rate for Payer: Humana Medicare	$72.15
Rate for Payer: Senior Whole Health Medicare Advantage	$70.74
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$70.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.59
Rate for Payer: Wellcare Medicare	$67.20

OPSCPY EXTEND RTD DRAW UNI/BI

Facility

$166.60

Service Code	HCPCS 92201
Hospital Charge Code	42102001
Hospital Revenue Code	920
Rate for Payer: Cash Price	$70.74

OPSCPY EXTEND RTD DRAW UNI/BI

Facility

$166.60

Service Code	HCPCS 92201
Hospital Charge Code	42102001
Hospital Revenue Code	920
Min. Negotiated Rate	$49.52
Max. Negotiated Rate	$133.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.74
Rate for Payer: Aetna Government	$70.74
Rate for Payer: Affinity Essential Plan 1&2	$49.52
Rate for Payer: Affinity Essential Plan 3&4	$49.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.52
Rate for Payer: Brighton Health Commercial	$124.95
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.29
Rate for Payer: Elderplan Medicare Advantage	$70.74
Rate for Payer: EmblemHealth Commercial	$70.74
Rate for Payer: Fidelis Essential Plan Aliesa	$60.13
Rate for Payer: Fidelis Essential Plan QHP	$62.96
Rate for Payer: Fidelis Medicare Advantage	$70.74
Rate for Payer: Fidelis Qualified Health Plan	$62.96
Rate for Payer: Group Health Inc Commercial	$70.74
Rate for Payer: Group Health Inc Medicare	$70.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.30
Rate for Payer: Hamaspik Choice Inc Medicare	$70.74
Rate for Payer: Healthfirst Medicare Advantage	$60.13
Rate for Payer: Healthfirst QHP	$70.74
Rate for Payer: Humana Medicare	$72.15
Rate for Payer: Senior Whole Health Medicare Advantage	$70.74
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$70.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.59
Rate for Payer: Wellcare Medicare	$67.20

OPT BLADELESS 5X75 STABILITY

Facility

$10.42

Hospital Charge Code	64905854
Hospital Revenue Code	270
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$8.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.21
Rate for Payer: Aetna Government	$5.21
Rate for Payer: Brighton Health Commercial	$7.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.09
Rate for Payer: Group Health Inc Commercial	$5.21
Rate for Payer: Group Health Inc Medicare	$3.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.21
Rate for Payer: Hamaspik Choice Inc Medicare	$5.21

OPTEMP CAUTERY

Facility

$12.76

Hospital Charge Code	40000285
Hospital Revenue Code	272
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.38
Rate for Payer: Aetna Government	$6.38
Rate for Payer: Brighton Health Commercial	$9.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.68
Rate for Payer: Group Health Inc Commercial	$6.38
Rate for Payer: Group Health Inc Medicare	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6.38

OPTHALMOLOGICAL SERVICE NW PT

Facility

$351.13

Service Code	HCPCS 92002
Hospital Charge Code	30103242
Hospital Revenue Code	450
Rate for Payer: Cash Price	$152.87

OPTHALMOLOGICAL SERVICE NW PT

Facility

$351.13

Service Code	HCPCS 92002
Hospital Charge Code	30103242
Hospital Revenue Code	450
Min. Negotiated Rate	$107.01
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.87
Rate for Payer: Aetna Government	$152.87
Rate for Payer: Affinity Essential Plan 1&2	$107.01
Rate for Payer: Affinity Essential Plan 3&4	$107.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.01
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$152.87
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$152.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: Elderplan Medicare Advantage	$152.87
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$129.94
Rate for Payer: Fidelis Essential Plan QHP	$136.05
Rate for Payer: Fidelis Medicare Advantage	$152.87
Rate for Payer: Fidelis Qualified Health Plan	$136.05
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.56
Rate for Payer: Hamaspik Choice Inc Medicare	$152.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$152.87
Rate for Payer: Humana Medicare	$155.93
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$152.87
Rate for Payer: Senior Whole Health Medicare Advantage	$152.87
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$152.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.30
Rate for Payer: Wellcare Medicare	$145.23

OPTIFLEX BASKET

Facility

$673.08

Hospital Charge Code	64905875
Hospital Revenue Code	270
Min. Negotiated Rate	$235.58
Max. Negotiated Rate	$538.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$370.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$336.54
Rate for Payer: Aetna Government	$336.54
Rate for Payer: Brighton Health Commercial	$504.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$538.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$457.69
Rate for Payer: Group Health Inc Commercial	$336.54
Rate for Payer: Group Health Inc Medicare	$235.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$336.54
Rate for Payer: Hamaspik Choice Inc Medicare	$336.54

OPTIVAC FUSION

Facility

$170.00

Hospital Charge Code	40202204
Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.00
Rate for Payer: Aetna Government	$85.00
Rate for Payer: Brighton Health Commercial	$127.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.60
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

OPTIVAC KIT 120 GRAM, TRIPLE MIX

Facility

$214.00

Service Code	HCPCS C1713
Hospital Charge Code	40202205
Hospital Revenue Code	278
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$224.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$128.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.05
Rate for Payer: EmblemHealth Commercial	$107.00
Rate for Payer: Fidelis Medicare Advantage	$224.70
Rate for Payer: Group Health Inc Commercial	$107.00
Rate for Payer: Group Health Inc Medicare	$74.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.00
Rate for Payer: Hamaspik Choice Inc Medicare	$107.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$139.10

OPTIVAC KIT 120 GRAM, TRIPLE MIX

Facility

$214.00

Service Code	HCPCS C1713
Hospital Charge Code	40202205
Hospital Revenue Code	278
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$107.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.00
Rate for Payer: Hamaspik Choice Inc Medicare	$107.00

OPTIVAC KIT 80 GRAM.DBL MIX

Facility

$118.00

Service Code	HCPCS C1713
Hospital Charge Code	40209449
Hospital Revenue Code	278
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$59.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.00
Rate for Payer: Hamaspik Choice Inc Medicare	$59.00

OPTIVAC KIT 80 GRAM.DBL MIX

Facility

$118.00

Service Code	HCPCS C1713
Hospital Charge Code	40209449
Hospital Revenue Code	278
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$70.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.85
Rate for Payer: EmblemHealth Commercial	$59.00
Rate for Payer: Fidelis Medicare Advantage	$123.90
Rate for Payer: Group Health Inc Commercial	$59.00
Rate for Payer: Group Health Inc Medicare	$41.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.00
Rate for Payer: Hamaspik Choice Inc Medicare	$59.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.70

OPTIVAL

Facility

$109.80

Service Code	HCPCS 93290 TC
Hospital Charge Code	30301327
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

OPTIVAL

Facility

$109.80

Service Code	HCPCS 93290 TC
Hospital Charge Code	30301327
Hospital Revenue Code	480
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.61
Rate for Payer: Aetna Government	$43.61
Rate for Payer: Affinity Essential Plan 1&2	$30.53
Rate for Payer: Affinity Essential Plan 3&4	$30.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$30.53
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Elderplan Medicare Advantage	$43.61
Rate for Payer: EmblemHealth Commercial	$43.61
Rate for Payer: Fidelis Essential Plan Aliesa	$37.07
Rate for Payer: Fidelis Essential Plan QHP	$38.81
Rate for Payer: Fidelis Medicare Advantage	$43.61
Rate for Payer: Fidelis Qualified Health Plan	$38.81
Rate for Payer: Group Health Inc Commercial	$43.61
Rate for Payer: Group Health Inc Medicare	$43.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$43.61
Rate for Payer: Healthfirst Medicare Advantage	$37.07
Rate for Payer: Healthfirst QHP	$43.61
Rate for Payer: Humana Medicare	$44.48
Rate for Payer: Senior Whole Health Medicare Advantage	$43.61
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$43.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.89
Rate for Payer: Wellcare Medicare	$41.43

ORABITAL IMPL

Facility

$9,471.08

Service Code	HCPCS 67550
Hospital Charge Code	40072560
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$7,103.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,471.17
Rate for Payer: Aetna Government	$4,471.17
Rate for Payer: Affinity Essential Plan 1&2	$3,129.82
Rate for Payer: Affinity Essential Plan 3&4	$3,129.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,129.82
Rate for Payer: Brighton Health Commercial	$7,103.31
Rate for Payer: Cash Price	$4,471.17
Rate for Payer: Cash Price	$4,471.17
Rate for Payer: Cash Price	$4,471.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,471.17
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	$4,471.17
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,800.49
Rate for Payer: Fidelis Essential Plan QHP	$3,979.34
Rate for Payer: Fidelis Medicare Advantage	$4,471.17
Rate for Payer: Fidelis Qualified Health Plan	$3,979.34
Rate for Payer: Group Health Inc Commercial	$4,471.17
Rate for Payer: Group Health Inc Medicare	$4,471.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,735.54
Rate for Payer: Hamaspik Choice Inc Medicare	$4,471.17
Rate for Payer: Healthfirst Medicare Advantage	$3,800.49
Rate for Payer: Healthfirst QHP	$4,471.17
Rate for Payer: Humana Medicare	$4,560.59
Rate for Payer: Senior Whole Health Medicare Advantage	$4,471.17
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$4,471.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,471.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,576.94
Rate for Payer: Wellcare Medicare	$4,247.61

ORABITAL IMPL

Facility

$9,471.08

Service Code	HCPCS 67550
Hospital Charge Code	40072560
Hospital Revenue Code	360
Rate for Payer: Cash Price	$4,471.17

ORAL ADMIN OF SUBOXONE 12-3MG

Facility

$82.54

Service Code	HCPCS H0033
Hospital Charge Code	30402553
Hospital Revenue Code	940
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$66.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.40
Rate for Payer: Aetna Government	$10.40
Rate for Payer: Brighton Health Commercial	$61.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.13
Rate for Payer: Group Health Inc Commercial	$41.27
Rate for Payer: Group Health Inc Medicare	$28.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.27
Rate for Payer: Hamaspik Choice Inc Medicare	$41.27
Rate for Payer: United Healthcare Commercial	$41.27

ORAL ADMIN OF SUBOXONE 2-0.5MG

Facility

$82.54

Service Code	HCPCS H0033
Hospital Charge Code	30402550
Hospital Revenue Code	900
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$66.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.40
Rate for Payer: Aetna Government	$10.40
Rate for Payer: Brighton Health Commercial	$61.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.13
Rate for Payer: Group Health Inc Commercial	$41.27
Rate for Payer: Group Health Inc Medicare	$28.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.27
Rate for Payer: Hamaspik Choice Inc Medicare	$41.27
Rate for Payer: United Healthcare Commercial	$41.27

Know your out-of-pocket cost for care.

All Charges