St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OSTEOMED SCREW 2.0X6MM

Facility

$132.00

Service Code	HCPCS C1713
Hospital Charge Code	40205526
Hospital Revenue Code	278
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$138.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$79.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.90
Rate for Payer: EmblemHealth Commercial	$66.00
Rate for Payer: Fidelis Medicare Advantage	$138.60
Rate for Payer: Group Health Inc Commercial	$66.00
Rate for Payer: Group Health Inc Medicare	$46.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.00
Rate for Payer: Hamaspik Choice Inc Medicare	$66.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$85.80

OSTEOMED SCREW 2.0X6MM

Facility

$132.00

Service Code	HCPCS C1713
Hospital Charge Code	40205526
Hospital Revenue Code	278
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$66.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$66.00
Rate for Payer: Hamaspik Choice Inc Medicare	$66.00

OSTEOMED SCREW 2.4MM X 12MM

Facility

$208.00

Service Code	HCPCS C1776
Hospital Charge Code	40205230
Hospital Revenue Code	278
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$104.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$104.00

OSTEOMED SCREW 2.4MM X 12MM

Facility

$208.00

Service Code	HCPCS C1776
Hospital Charge Code	40205230
Hospital Revenue Code	278
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$124.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.60
Rate for Payer: EmblemHealth Commercial	$104.00
Rate for Payer: Fidelis Medicare Advantage	$218.40
Rate for Payer: Group Health Inc Commercial	$104.00
Rate for Payer: Group Health Inc Medicare	$72.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.00
Rate for Payer: Hamaspik Choice Inc Medicare	$104.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.20

OSTEOMED SCREW 2.4MM X 6MM

Facility

$116.00

Service Code	HCPCS C1776
Hospital Charge Code	40205231
Hospital Revenue Code	278
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$58.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00

OSTEOMED SCREW 2.4MM X 6MM

Facility

$116.00

Service Code	HCPCS C1776
Hospital Charge Code	40205231
Hospital Revenue Code	278
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$69.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.70
Rate for Payer: EmblemHealth Commercial	$58.00
Rate for Payer: Fidelis Medicare Advantage	$121.80
Rate for Payer: Group Health Inc Commercial	$58.00
Rate for Payer: Group Health Inc Medicare	$40.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.40

OSTEOMED SCREW 313-3532,42,48

Facility

$218.00

Service Code	HCPCS C1713
Hospital Charge Code	40205356
Hospital Revenue Code	278
Min. Negotiated Rate	$76.30
Max. Negotiated Rate	$228.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$130.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.35
Rate for Payer: EmblemHealth Commercial	$109.00
Rate for Payer: Fidelis Medicare Advantage	$228.90
Rate for Payer: Group Health Inc Commercial	$109.00
Rate for Payer: Group Health Inc Medicare	$76.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.00
Rate for Payer: Hamaspik Choice Inc Medicare	$109.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$141.70

OSTEOMED SCREW 313-3532,42,48

Facility

$218.00

Service Code	HCPCS C1713
Hospital Charge Code	40205356
Hospital Revenue Code	278
Min. Negotiated Rate	$109.00
Max. Negotiated Rate	$109.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$109.00
Rate for Payer: Hamaspik Choice Inc Medicare	$109.00

OSTEOMED SCREW 4MMX2.0MM

Facility

$124.00

Service Code	HCPCS C1776
Hospital Charge Code	40206059
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$62.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.00
Rate for Payer: Hamaspik Choice Inc Medicare	$62.00

OSTEOMED SCREW 4MMX2.0MM

Facility

$124.00

Service Code	HCPCS C1776
Hospital Charge Code	40206059
Hospital Revenue Code	278
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$74.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.30
Rate for Payer: EmblemHealth Commercial	$62.00
Rate for Payer: Fidelis Medicare Advantage	$130.20
Rate for Payer: Group Health Inc Commercial	$62.00
Rate for Payer: Group Health Inc Medicare	$43.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.00
Rate for Payer: Hamaspik Choice Inc Medicare	$62.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$80.60

OSTEOMED SCRW 8MM X 2.0MM

Facility

$150.00

Service Code	HCPCS C1776
Hospital Charge Code	40205270
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

OSTEOMED SCRW 8MM X 2.0MM

Facility

$150.00

Service Code	HCPCS C1776
Hospital Charge Code	40205270
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: EmblemHealth Commercial	$75.00
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

OSTEOMYELITIS WITH CC

Facility

$34,829.41

Service Code	MSDRG 540
Min. Negotiated Rate	$11,132.10
Max. Negotiated Rate	$34,829.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19,141.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25,330.48
Rate for Payer: Aetna Government	$25,330.48
Rate for Payer: Brighton Health Commercial	$18,823.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25,837.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22,418.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$18,500.80
Rate for Payer: Elderplan Medicare Advantage	$24,063.96
Rate for Payer: EmblemHealth Commercial	$11,132.10
Rate for Payer: Fidelis Medicare Advantage	$25,330.48
Rate for Payer: Group Health Inc Commercial	$25,330.48
Rate for Payer: Group Health Inc Medicare	$25,330.48
Rate for Payer: Hamaspik Choice Inc Medicare	$25,330.48
Rate for Payer: Healthfirst Medicare Advantage	$11,778.67
Rate for Payer: Humana Medicare	$34,829.41
Rate for Payer: Senior Whole Health Medicare Advantage	$25,330.48
Rate for Payer: United Healthcare Commercial	$25,817.30
Rate for Payer: United Healthcare Medicare Advantage	$25,330.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,330.48
Rate for Payer: Wellcare Medicare	$24,063.96

OSTEOMYELITIS WITH MCC

Facility

$47,913.65

Service Code	MSDRG 539
Min. Negotiated Rate	$16,203.52
Max. Negotiated Rate	$47,913.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29,259.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34,846.29
Rate for Payer: Aetna Government	$34,846.29
Rate for Payer: Brighton Health Commercial	$28,773.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35,543.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34,268.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28,279.92
Rate for Payer: Elderplan Medicare Advantage	$33,103.98
Rate for Payer: EmblemHealth Commercial	$17,016.20
Rate for Payer: Fidelis Medicare Advantage	$34,846.29
Rate for Payer: Group Health Inc Commercial	$34,846.29
Rate for Payer: Group Health Inc Medicare	$34,846.29
Rate for Payer: Hamaspik Choice Inc Medicare	$34,846.29
Rate for Payer: Healthfirst Medicare Advantage	$16,203.52
Rate for Payer: Humana Medicare	$47,913.65
Rate for Payer: Senior Whole Health Medicare Advantage	$34,846.29
Rate for Payer: United Healthcare Commercial	$39,463.76
Rate for Payer: United Healthcare Medicare Advantage	$34,846.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34,846.29
Rate for Payer: Wellcare Medicare	$33,103.98

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$26,433.94

Service Code	MSDRG 541
Min. Negotiated Rate	$7,356.49
Max. Negotiated Rate	$26,433.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,649.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19,224.68
Rate for Payer: Aetna Government	$19,224.68
Rate for Payer: Brighton Health Commercial	$12,439.55
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19,609.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,815.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,226.04
Rate for Payer: Elderplan Medicare Advantage	$18,263.45
Rate for Payer: EmblemHealth Commercial	$7,356.49
Rate for Payer: Fidelis Medicare Advantage	$19,224.68
Rate for Payer: Group Health Inc Commercial	$19,224.68
Rate for Payer: Group Health Inc Medicare	$19,224.68
Rate for Payer: Hamaspik Choice Inc Medicare	$19,224.68
Rate for Payer: Healthfirst Medicare Advantage	$8,939.48
Rate for Payer: Humana Medicare	$26,433.94
Rate for Payer: Senior Whole Health Medicare Advantage	$19,224.68
Rate for Payer: United Healthcare Commercial	$17,061.06
Rate for Payer: United Healthcare Medicare Advantage	$19,224.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19,224.68
Rate for Payer: Wellcare Medicare	$18,263.45

OSTEOPATHIC MANIP. 3-4 BODY REGIO

Facility

$113.40

Service Code	HCPCS 98926
Hospital Charge Code	30300086
Hospital Revenue Code	530
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$90.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$21.00
Rate for Payer: Affinity Essential Plan 3&4	$21.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.00
Rate for Payer: Brighton Health Commercial	$85.05
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.11
Rate for Payer: Elderplan Medicare Advantage	$30.00
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst Medicare Advantage	$25.50
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: United Healthcare Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

OSTEOPATHIC MANIP. 3-4 BODY REGIO

Facility

$113.40

Service Code	HCPCS 98926
Hospital Charge Code	30300086
Hospital Revenue Code	530
Rate for Payer: Cash Price	$30.00

OSTEOPATHIC MANIPULATION

Facility

$113.40

Service Code	HCPCS 98925
Hospital Charge Code	30300151
Hospital Revenue Code	530
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$90.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$21.00
Rate for Payer: Affinity Essential Plan 3&4	$21.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.00
Rate for Payer: Brighton Health Commercial	$85.05
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.11
Rate for Payer: Elderplan Medicare Advantage	$30.00
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst Medicare Advantage	$25.50
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: United Healthcare Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

OSTEOPATHIC MANIPULATION

Facility

$74.28

Service Code	HCPCS 98925
Hospital Charge Code	30103254
Hospital Revenue Code	530
Rate for Payer: Cash Price	$30.00

OSTEOPATHIC MANIPULATION

Facility

$113.40

Service Code	HCPCS 98925
Hospital Charge Code	30300151
Hospital Revenue Code	530
Rate for Payer: Cash Price	$30.00

OSTEOPATHIC MANIPULATION

Facility

$74.28

Service Code	HCPCS 98925
Hospital Charge Code	30103254
Hospital Revenue Code	530
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$59.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$21.00
Rate for Payer: Affinity Essential Plan 3&4	$21.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.00
Rate for Payer: Brighton Health Commercial	$55.71
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.51
Rate for Payer: Elderplan Medicare Advantage	$30.00
Rate for Payer: EmblemHealth Commercial	$30.00
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$30.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.14
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst Medicare Advantage	$25.50
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: United Healthcare Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

OSTEOPATH MANJ 1-2 REGIONS

Facility

$113.40

Service Code	HCPCS 98925
Hospital Charge Code	30106430
Hospital Revenue Code	450
Rate for Payer: Cash Price	$30.00

OSTEOPATH MANJ 1-2 REGIONS

Facility

$113.40

Service Code	HCPCS 98925
Hospital Charge Code	30106430
Hospital Revenue Code	450
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$21.00
Rate for Payer: Affinity Essential Plan 3&4	$21.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$30.00
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
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	$30.00
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
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	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$30.00
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

OSTEOPATH MANJ 3-4 REGIONS

Facility

$113.40

Service Code	HCPCS 98926
Hospital Charge Code	30106431
Hospital Revenue Code	450
Rate for Payer: Cash Price	$30.00

OSTEOPATH MANJ 3-4 REGIONS

Facility

$113.40

Service Code	HCPCS 98926
Hospital Charge Code	30106431
Hospital Revenue Code	450
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Affinity Essential Plan 1&2	$21.00
Rate for Payer: Affinity Essential Plan 3&4	$21.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$30.00
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.00
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	$30.00
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$25.50
Rate for Payer: Fidelis Essential Plan QHP	$26.70
Rate for Payer: Fidelis Medicare Advantage	$30.00
Rate for Payer: Fidelis Qualified Health Plan	$26.70
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	$56.70
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$30.00
Rate for Payer: Humana Medicare	$30.60
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$30.00
Rate for Payer: Senior Whole Health Medicare Advantage	$30.00
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$30.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.00
Rate for Payer: Wellcare Medicare	$28.50

Know your out-of-pocket cost for care.

All Charges