St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES

Professional

Both

$344.65

Service Code	HCPCS 99203
Min. Negotiated Rate	$258.49
Max. Negotiated Rate	$258.49
Rate for Payer: Cash Price	$92.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$258.49
Rate for Payer: SOMOS Essential	$258.49

PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES

Professional

Both

$548.14

Service Code	HCPCS 99204
Min. Negotiated Rate	$411.10
Max. Negotiated Rate	$411.10
Rate for Payer: Cash Price	$150.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$411.10
Rate for Payer: SOMOS Essential	$411.10

PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES

Professional

Both

$197.30

Service Code	HCPCS 99202
Min. Negotiated Rate	$147.98
Max. Negotiated Rate	$147.98
Rate for Payer: Cash Price	$53.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$147.98
Rate for Payer: SOMOS Essential	$147.98

PROFILE MINI DRILL

Facility

$375.00

Hospital Charge Code	64907191
Hospital Revenue Code	279
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$300.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$187.50
Rate for Payer: Aetna Government	$187.50
Rate for Payer: Brighton Health Commercial	$281.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$255.00
Rate for Payer: Group Health Inc Commercial	$187.50
Rate for Payer: Group Health Inc Medicare	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50

PROFILE PRE-DIALYSIS

Facility

$13.90

Service Code	HCPCS 84540
Hospital Charge Code	40602495
Hospital Revenue Code	301
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$10.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.56
Rate for Payer: Aetna Government	$5.56
Rate for Payer: Affinity Essential Plan 1&2	$3.89
Rate for Payer: Affinity Essential Plan 3&4	$3.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.89
Rate for Payer: Brighton Health Commercial	$10.42
Rate for Payer: Cash Price	$5.56
Rate for Payer: Cash Price	$5.56
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.38
Rate for Payer: Elderplan Medicare Advantage	$5.56
Rate for Payer: EmblemHealth Commercial	$5.56
Rate for Payer: Fidelis Essential Plan Aliesa	$4.73
Rate for Payer: Fidelis Essential Plan QHP	$4.95
Rate for Payer: Fidelis Medicare Advantage	$5.56
Rate for Payer: Fidelis Qualified Health Plan	$4.95
Rate for Payer: Group Health Inc Commercial	$5.56
Rate for Payer: Group Health Inc Medicare	$5.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.95
Rate for Payer: Hamaspik Choice Inc Medicare	$5.56
Rate for Payer: Healthfirst Medicare Advantage	$5.56
Rate for Payer: Healthfirst QHP	$5.56
Rate for Payer: Humana Medicare	$5.67
Rate for Payer: Senior Whole Health Medicare Advantage	$5.56
Rate for Payer: United Healthcare Commercial	$6.01
Rate for Payer: United Healthcare Medicare Advantage	$5.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.45
Rate for Payer: Wellcare Medicare	$5.00

PROFILE PRE-DIALYSIS

Facility

$13.90

Service Code	HCPCS 84540
Hospital Charge Code	40602495
Hospital Revenue Code	301
Rate for Payer: Cash Price	$5.56

PROFILE VII(HEPATIC FUNC PANEL)

Facility

$21.15

Service Code	HCPCS 80048
Hospital Charge Code	40602505
Hospital Revenue Code	301
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$15.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.46
Rate for Payer: Aetna Government	$8.46
Rate for Payer: Affinity Essential Plan 1&2	$5.92
Rate for Payer: Affinity Essential Plan 3&4	$5.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.92
Rate for Payer: Brighton Health Commercial	$15.86
Rate for Payer: Cash Price	$8.46
Rate for Payer: Cash Price	$8.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.38
Rate for Payer: Elderplan Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$8.46
Rate for Payer: Fidelis Essential Plan Aliesa	$7.19
Rate for Payer: Fidelis Essential Plan QHP	$7.53
Rate for Payer: Fidelis Medicare Advantage	$8.46
Rate for Payer: Fidelis Qualified Health Plan	$7.53
Rate for Payer: Group Health Inc Commercial	$8.46
Rate for Payer: Group Health Inc Medicare	$8.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.58
Rate for Payer: Hamaspik Choice Inc Medicare	$8.46
Rate for Payer: Healthfirst Medicare Advantage	$8.46
Rate for Payer: Healthfirst QHP	$8.46
Rate for Payer: Humana Medicare	$8.63
Rate for Payer: Senior Whole Health Medicare Advantage	$8.46
Rate for Payer: United Healthcare Commercial	$10.72
Rate for Payer: United Healthcare Medicare Advantage	$8.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.77
Rate for Payer: Wellcare Medicare	$7.61

PROFILE VII(HEPATIC FUNC PANEL)

Facility

$21.15

Service Code	HCPCS 80048
Hospital Charge Code	40602505
Hospital Revenue Code	301
Rate for Payer: Cash Price	$8.46

PROGESTERONE_

Facility

$52.15

Service Code	HCPCS 84144
Hospital Charge Code	40609110
Hospital Revenue Code	300
Rate for Payer: Cash Price	$20.86

PROGESTERONE_

Facility

$52.15

Service Code	HCPCS 84144
Hospital Charge Code	40609110
Hospital Revenue Code	300
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$39.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.86
Rate for Payer: Aetna Government	$20.86
Rate for Payer: Affinity Essential Plan 1&2	$14.60
Rate for Payer: Affinity Essential Plan 3&4	$14.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.60
Rate for Payer: Brighton Health Commercial	$39.11
Rate for Payer: Cash Price	$20.86
Rate for Payer: Cash Price	$20.86
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.06
Rate for Payer: Elderplan Medicare Advantage	$20.86
Rate for Payer: EmblemHealth Commercial	$20.86
Rate for Payer: Fidelis Essential Plan Aliesa	$17.73
Rate for Payer: Fidelis Essential Plan QHP	$18.57
Rate for Payer: Fidelis Medicare Advantage	$20.86
Rate for Payer: Fidelis Qualified Health Plan	$18.57
Rate for Payer: Group Health Inc Commercial	$20.86
Rate for Payer: Group Health Inc Medicare	$20.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.08
Rate for Payer: Hamaspik Choice Inc Medicare	$20.86
Rate for Payer: Healthfirst Medicare Advantage	$20.86
Rate for Payer: Healthfirst QHP	$20.86
Rate for Payer: Humana Medicare	$21.28
Rate for Payer: Senior Whole Health Medicare Advantage	$20.86
Rate for Payer: United Healthcare Commercial	$26.42
Rate for Payer: United Healthcare Medicare Advantage	$20.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16.69
Rate for Payer: Wellcare Medicare	$18.77

PROGESTERONE 8 % VA GEL [21321]

Facility

$31.87

Service Code	NDC 00023615108
Hospital Charge Code	00023615108
Hospital Revenue Code	250
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$25.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.94
Rate for Payer: Aetna Government	$15.94
Rate for Payer: Brighton Health Commercial	$23.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.67
Rate for Payer: Group Health Inc Commercial	$15.94
Rate for Payer: Group Health Inc Medicare	$11.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.94
Rate for Payer: Hamaspik Choice Inc Medicare	$15.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.72

PROGESTERONE 8% VAGINAL GEL

Facility

$30.00

Hospital Charge Code	41647039
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

PROGESTERONE 8% VAGINAL GEL

Facility

$30.00

Hospital Charge Code	41657039
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.00
Rate for Payer: Aetna Government	$15.00
Rate for Payer: Brighton Health Commercial	$22.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.40
Rate for Payer: Group Health Inc Commercial	$15.00
Rate for Payer: Group Health Inc Medicare	$10.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.50

PROGRAM INTAKE ASSESSMENT

Facility

$142.53

Service Code	HCPCS T1023
Hospital Charge Code	30400240
Hospital Revenue Code	510
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$78.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
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	$71.26
Rate for Payer: Hamaspik Choice Inc Medicare	$71.26
Rate for Payer: United Healthcare Commercial	$222.00

PROGRAMMER INTESTIM

Facility

$1,950.00

Service Code	HCPCS L8681
Hospital Charge Code	64906223
Hospital Revenue Code	278
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$2,047.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,072.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$751.30
Rate for Payer: Aetna Government	$751.30
Rate for Payer: Brighton Health Commercial	$1,170.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$975.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,121.25
Rate for Payer: EmblemHealth Commercial	$975.00
Rate for Payer: Fidelis Medicare Advantage	$2,047.50
Rate for Payer: Group Health Inc Commercial	$975.00
Rate for Payer: Group Health Inc Medicare	$682.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,267.50

PROGRAMMER INTESTIM

Facility

$1,950.00

Service Code	HCPCS L8681
Hospital Charge Code	64906223
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$975.00
Rate for Payer: Hamaspik Choice Inc Medicare	$975.00

PROINSULIN

Facility

$66.73

Service Code	HCPCS 84206
Hospital Charge Code	40609746
Hospital Revenue Code	301
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$50.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.69
Rate for Payer: Aetna Government	$26.69
Rate for Payer: Affinity Essential Plan 1&2	$18.68
Rate for Payer: Affinity Essential Plan 3&4	$18.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.68
Rate for Payer: Brighton Health Commercial	$50.05
Rate for Payer: Cash Price	$26.69
Rate for Payer: Cash Price	$26.69
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.97
Rate for Payer: Elderplan Medicare Advantage	$26.69
Rate for Payer: EmblemHealth Commercial	$26.69
Rate for Payer: Fidelis Essential Plan Aliesa	$22.69
Rate for Payer: Fidelis Essential Plan QHP	$23.75
Rate for Payer: Fidelis Medicare Advantage	$26.69
Rate for Payer: Fidelis Qualified Health Plan	$23.75
Rate for Payer: Group Health Inc Commercial	$26.69
Rate for Payer: Group Health Inc Medicare	$26.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.36
Rate for Payer: Hamaspik Choice Inc Medicare	$26.69
Rate for Payer: Healthfirst Medicare Advantage	$26.69
Rate for Payer: Healthfirst QHP	$26.69
Rate for Payer: Humana Medicare	$27.22
Rate for Payer: Senior Whole Health Medicare Advantage	$26.69
Rate for Payer: United Healthcare Commercial	$22.56
Rate for Payer: United Healthcare Medicare Advantage	$26.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21.35
Rate for Payer: Wellcare Medicare	$24.02

PROINSULIN

Facility

$66.73

Service Code	HCPCS 84206
Hospital Charge Code	40609746
Hospital Revenue Code	301
Rate for Payer: Cash Price	$26.69

PRO. & INTERP. OF CYTOLOGIC SMEAR

Facility

$531.56

Service Code	HCPCS D0480
Hospital Charge Code	42303279
Hospital Revenue Code	361
Min. Negotiated Rate	$29.31
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$292.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.31
Rate for Payer: Aetna Government	$29.31
Rate for Payer: Brighton Health Commercial	$398.67
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	$265.78
Rate for Payer: Group Health Inc Medicare	$186.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.78
Rate for Payer: Hamaspik Choice Inc Medicare	$265.78

PROLACTIN

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40602560
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.38

PROLACTIN

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40602560
Hospital Revenue Code	301
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$36.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.38
Rate for Payer: Aetna Government	$19.38
Rate for Payer: Affinity Essential Plan 1&2	$13.57
Rate for Payer: Affinity Essential Plan 3&4	$13.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.57
Rate for Payer: Brighton Health Commercial	$36.34
Rate for Payer: Cash Price	$19.38
Rate for Payer: Cash Price	$19.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.07
Rate for Payer: Elderplan Medicare Advantage	$19.38
Rate for Payer: EmblemHealth Commercial	$19.38
Rate for Payer: Fidelis Essential Plan Aliesa	$16.47
Rate for Payer: Fidelis Essential Plan QHP	$17.25
Rate for Payer: Fidelis Medicare Advantage	$19.38
Rate for Payer: Fidelis Qualified Health Plan	$17.25
Rate for Payer: Group Health Inc Commercial	$19.38
Rate for Payer: Group Health Inc Medicare	$19.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.22
Rate for Payer: Hamaspik Choice Inc Medicare	$19.38
Rate for Payer: Healthfirst Medicare Advantage	$19.38
Rate for Payer: Healthfirst QHP	$19.38
Rate for Payer: Humana Medicare	$19.77
Rate for Payer: Senior Whole Health Medicare Advantage	$19.38
Rate for Payer: United Healthcare Commercial	$24.54
Rate for Payer: United Healthcare Medicare Advantage	$19.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.50
Rate for Payer: Wellcare Medicare	$17.44

PROLACTIN_

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40609111
Hospital Revenue Code	300
Rate for Payer: Cash Price	$19.38

PROLACTIN_

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40609111
Hospital Revenue Code	300
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$36.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.38
Rate for Payer: Aetna Government	$19.38
Rate for Payer: Affinity Essential Plan 1&2	$13.57
Rate for Payer: Affinity Essential Plan 3&4	$13.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.57
Rate for Payer: Brighton Health Commercial	$36.34
Rate for Payer: Cash Price	$19.38
Rate for Payer: Cash Price	$19.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.07
Rate for Payer: Elderplan Medicare Advantage	$19.38
Rate for Payer: EmblemHealth Commercial	$19.38
Rate for Payer: Fidelis Essential Plan Aliesa	$16.47
Rate for Payer: Fidelis Essential Plan QHP	$17.25
Rate for Payer: Fidelis Medicare Advantage	$19.38
Rate for Payer: Fidelis Qualified Health Plan	$17.25
Rate for Payer: Group Health Inc Commercial	$19.38
Rate for Payer: Group Health Inc Medicare	$19.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.22
Rate for Payer: Hamaspik Choice Inc Medicare	$19.38
Rate for Payer: Healthfirst Medicare Advantage	$19.38
Rate for Payer: Healthfirst QHP	$19.38
Rate for Payer: Humana Medicare	$19.77
Rate for Payer: Senior Whole Health Medicare Advantage	$19.38
Rate for Payer: United Healthcare Commercial	$24.54
Rate for Payer: United Healthcare Medicare Advantage	$19.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.50
Rate for Payer: Wellcare Medicare	$17.44

PROLACTIN 1-10

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40609748
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.38

PROLACTIN 1-10

Facility

$48.45

Service Code	HCPCS 84146
Hospital Charge Code	40609748
Hospital Revenue Code	301
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$36.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.38
Rate for Payer: Aetna Government	$19.38
Rate for Payer: Affinity Essential Plan 1&2	$13.57
Rate for Payer: Affinity Essential Plan 3&4	$13.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$13.57
Rate for Payer: Brighton Health Commercial	$36.34
Rate for Payer: Cash Price	$19.38
Rate for Payer: Cash Price	$19.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.07
Rate for Payer: Elderplan Medicare Advantage	$19.38
Rate for Payer: EmblemHealth Commercial	$19.38
Rate for Payer: Fidelis Essential Plan Aliesa	$16.47
Rate for Payer: Fidelis Essential Plan QHP	$17.25
Rate for Payer: Fidelis Medicare Advantage	$19.38
Rate for Payer: Fidelis Qualified Health Plan	$17.25
Rate for Payer: Group Health Inc Commercial	$19.38
Rate for Payer: Group Health Inc Medicare	$19.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.22
Rate for Payer: Hamaspik Choice Inc Medicare	$19.38
Rate for Payer: Healthfirst Medicare Advantage	$19.38
Rate for Payer: Healthfirst QHP	$19.38
Rate for Payer: Humana Medicare	$19.77
Rate for Payer: Senior Whole Health Medicare Advantage	$19.38
Rate for Payer: United Healthcare Commercial	$24.54
Rate for Payer: United Healthcare Medicare Advantage	$19.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.50
Rate for Payer: Wellcare Medicare	$17.44

Know your out-of-pocket cost for care.

All Charges