St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PEAK FLOW METR EVALUATION Q6H

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306341
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PEAK FLOW METR EVALUATION Q8H

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306340
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PEAK FLOW METR EVALUATION Q8H

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306340
Hospital Revenue Code	460
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$383.29
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

PEAK FLOW METR EVALUATION QID

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306339
Hospital Revenue Code	460
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$383.29
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

PEAK FLOW METR EVALUATION QID

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306339
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PEAK FLOW METR EVALUTION TID

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306200
Hospital Revenue Code	460
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$383.29
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

PEAK FLOW METR EVALUTION TID

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306200
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PEAK FLOW TIMES ONE

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306210
Hospital Revenue Code	460
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$383.29
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

PEAK FLOW TIMES ONE

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	40306210
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PEDATROL UNIT

Facility

$12.05

Hospital Charge Code	40204820
Hospital Revenue Code	270
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$9.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.02
Rate for Payer: Aetna Government	$6.02
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.19
Rate for Payer: Group Health Inc Commercial	$6.02
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.02
Rate for Payer: Hamaspik Choice Inc Medicare	$6.02

PED CRITICAL CARE INITIAL

Facility

$2,330.80

Service Code	HCPCS 99471
Hospital Charge Code	30306438
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$1,281.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,281.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$663.84
Rate for Payer: Aetna Government	$663.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$1,165.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1,165.40
Rate for Payer: United Healthcare Commercial	$222.00

PED CRITICAL CARE SUBSQ

Facility

$1,181.83

Service Code	HCPCS 99472
Hospital Charge Code	30306439
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$650.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$650.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$306.22
Rate for Payer: Aetna Government	$306.22
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$590.92
Rate for Payer: Hamaspik Choice Inc Medicare	$590.92
Rate for Payer: United Healthcare Commercial	$222.00

PEDIAC FEMORAL NAIL 6.5MMX36CM

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Charge Code	40202044
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,568.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,345.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,467.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,223.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,406.45
Rate for Payer: EmblemHealth Commercial	$1,223.00
Rate for Payer: Fidelis Medicare Advantage	$2,568.30
Rate for Payer: Group Health Inc Commercial	$1,223.00
Rate for Payer: Group Health Inc Medicare	$856.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,223.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,223.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,589.90

PEDIAC FEMORAL NAIL 6.5MMX36CM

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Charge Code	40202044
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.00
Max. Negotiated Rate	$1,223.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,223.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,223.00

PEDIATRIC ARMBOARD

Facility

$1.77

Hospital Charge Code	40204875
Hospital Revenue Code	270
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.20
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89

PEDI-BAG

Facility

$6.73

Hospital Charge Code	40204824
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

PEDICLE SOFT TISSUE GRAFT PROCEDU

Facility

$839.00

Service Code	HCPCS D4270
Hospital Charge Code	42300890
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,763.60

PEDICLE SOFT TISSUE GRAFT PROCEDU

Facility

$839.00

Service Code	HCPCS D4270
Hospital Charge Code	42300890
Hospital Revenue Code	361
Min. Negotiated Rate	$419.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$461.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,763.60
Rate for Payer: Aetna Government	$1,763.60
Rate for Payer: Affinity Essential Plan 1&2	$1,234.52
Rate for Payer: Affinity Essential Plan 3&4	$1,234.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,234.52
Rate for Payer: Brighton Health Commercial	$629.25
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,763.60
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	$1,763.60
Rate for Payer: EmblemHealth Commercial	$1,763.60
Rate for Payer: Fidelis Essential Plan Aliesa	$1,499.06
Rate for Payer: Fidelis Essential Plan QHP	$1,569.60
Rate for Payer: Fidelis Medicare Advantage	$1,763.60
Rate for Payer: Fidelis Qualified Health Plan	$1,569.60
Rate for Payer: Group Health Inc Commercial	$1,763.60
Rate for Payer: Group Health Inc Medicare	$1,763.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$419.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,763.60
Rate for Payer: Healthfirst Medicare Advantage	$1,499.06
Rate for Payer: Healthfirst QHP	$1,763.60
Rate for Payer: Humana Medicare	$1,798.87
Rate for Payer: Senior Whole Health Medicare Advantage	$1,763.60
Rate for Payer: United Healthcare Medicare Advantage	$1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,410.88
Rate for Payer: Wellcare Medicare	$1,675.42

PEDIPACK

Facility

$101.25

Service Code	HCPCS 86932
Hospital Charge Code	40701197
Hospital Revenue Code	302
Min. Negotiated Rate	$32.47
Max. Negotiated Rate	$75.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.38
Rate for Payer: Aetna Government	$46.38
Rate for Payer: Affinity Essential Plan 1&2	$32.47
Rate for Payer: Affinity Essential Plan 3&4	$32.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$32.47
Rate for Payer: Brighton Health Commercial	$75.94
Rate for Payer: Cash Price	$46.38
Rate for Payer: Cash Price	$46.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.66
Rate for Payer: Elderplan Medicare Advantage	$46.38
Rate for Payer: EmblemHealth Commercial	$46.38
Rate for Payer: Fidelis Essential Plan Aliesa	$39.42
Rate for Payer: Fidelis Essential Plan QHP	$41.28
Rate for Payer: Fidelis Medicare Advantage	$46.38
Rate for Payer: Fidelis Qualified Health Plan	$41.28
Rate for Payer: Group Health Inc Commercial	$46.38
Rate for Payer: Group Health Inc Medicare	$46.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.62
Rate for Payer: Hamaspik Choice Inc Medicare	$46.38
Rate for Payer: Healthfirst Medicare Advantage	$46.38
Rate for Payer: Healthfirst QHP	$46.38
Rate for Payer: Humana Medicare	$47.31
Rate for Payer: Senior Whole Health Medicare Advantage	$46.38
Rate for Payer: United Healthcare Commercial	$43.76
Rate for Payer: United Healthcare Medicare Advantage	$46.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.10
Rate for Payer: Wellcare Medicare	$41.74

PEDIPACK

Facility

$101.25

Service Code	HCPCS 86932
Hospital Charge Code	40701197
Hospital Revenue Code	302
Rate for Payer: Cash Price	$46.38

PED-OXYGEN TENT/CROUPETTE

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306215
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

PED-OXYGEN TENT/CROUPETTE

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306215
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

PEEK CUST. CRANIAL IMPL XLARGE

Facility

$40,682.00

Service Code	HCPCS C1713
Hospital Charge Code	64904147
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$42,716.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,375.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$24,409.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,341.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,392.15
Rate for Payer: EmblemHealth Commercial	$20,341.00
Rate for Payer: Fidelis Medicare Advantage	$42,716.10
Rate for Payer: Group Health Inc Commercial	$20,341.00
Rate for Payer: Group Health Inc Medicare	$14,238.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,341.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,341.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,443.30

PEEK CUST. CRANIAL IMPL XLARGE

Facility

$40,682.00

Service Code	HCPCS C1713
Hospital Charge Code	64904147
Hospital Revenue Code	278
Min. Negotiated Rate	$20,341.00
Max. Negotiated Rate	$20,341.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,341.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,341.00

PEG 3350 17 G PO PACK [100062]

Facility

$1.67

Service Code	NDC 00904693186
Hospital Charge Code	00904693186
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.84
Rate for Payer: Aetna Government	$0.84
Rate for Payer: Brighton Health Commercial	$1.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.14
Rate for Payer: Group Health Inc Commercial	$0.84
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.84
Rate for Payer: Hamaspik Choice Inc Medicare	$0.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.09

Know your out-of-pocket cost for care.

All Charges