St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA

Professional

Both

$9,862.06

Service Code	HCPCS 61345
Min. Negotiated Rate	$7,396.54
Max. Negotiated Rate	$7,396.54
Rate for Payer: Cash Price	$2,599.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,396.54
Rate for Payer: SOMOS Essential	$7,396.54

PROTHESIS PENILE 12-14MM DIA.5CML

Facility

$110.00

Service Code	HCPCS C1813
Hospital Charge Code	64906517
Hospital Revenue Code	278
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$55.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.00
Rate for Payer: Hamaspik Choice Inc Medicare	$55.00

PROTHESIS PENILE 12-14MM DIA.5CML

Facility

$110.00

Service Code	HCPCS C1813
Hospital Charge Code	64906517
Hospital Revenue Code	278
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$3,775.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$66.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.25
Rate for Payer: EmblemHealth Commercial	$55.00
Rate for Payer: Fidelis Medicare Advantage	$115.50
Rate for Payer: Group Health Inc Commercial	$55.00
Rate for Payer: Group Health Inc Medicare	$38.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.00
Rate for Payer: Hamaspik Choice Inc Medicare	$55.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.50

PROTHESIS SCROTAL W/ PUMP

Facility

$25,995.00

Service Code	HCPCS C1813
Hospital Charge Code	64907151
Hospital Revenue Code	278
Min. Negotiated Rate	$12,997.50
Max. Negotiated Rate	$12,997.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,997.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12,997.50

PROTHESIS SCROTAL W/ PUMP

Facility

$25,995.00

Service Code	HCPCS C1813
Hospital Charge Code	64907151
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$27,294.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14,297.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$15,597.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12,997.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,947.12
Rate for Payer: EmblemHealth Commercial	$12,997.50
Rate for Payer: Fidelis Medicare Advantage	$27,294.75
Rate for Payer: Group Health Inc Commercial	$12,997.50
Rate for Payer: Group Health Inc Medicare	$9,098.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,997.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12,997.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16,896.75

PR OTH RESP PROC, GROUP

Professional

Both

$55.93

Service Code	HCPCS G0239
Min. Negotiated Rate	$41.95
Max. Negotiated Rate	$41.95
Rate for Payer: Cash Price	$15.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.95
Rate for Payer: SOMOS Essential	$41.95

PR OTH RESP PROC, INDIV

Professional

Both

$45.85

Service Code	HCPCS G0238
Min. Negotiated Rate	$34.39
Max. Negotiated Rate	$34.39
Rate for Payer: Cash Price	$12.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34.39
Rate for Payer: SOMOS Essential	$34.39

PROTHROMBIN COMP HUMAN 500 UNITS

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41646495
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Cash Price	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76

PROTHROMBIN COMP HUMAN 500 UNITS

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41646495
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.28
Rate for Payer: Aetna Government	$2.28
Rate for Payer: Affinity Essential Plan 1&2	$1.60
Rate for Payer: Affinity Essential Plan 3&4	$1.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.60
Rate for Payer: Brighton Health Commercial	$2.11
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cash Price	$2.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.02
Rate for Payer: Elderplan Medicare Advantage	$2.28
Rate for Payer: EmblemHealth Commercial	$2.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.28
Rate for Payer: Fidelis Essential Plan Aliesa	$2.28
Rate for Payer: Fidelis Essential Plan QHP	$2.39
Rate for Payer: Fidelis Medicare Advantage	$2.28
Rate for Payer: Fidelis Qualified Health Plan	$2.39
Rate for Payer: Group Health Inc Commercial	$2.28
Rate for Payer: Group Health Inc Medicare	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: Healthfirst Medicare Advantage	$1.94
Rate for Payer: Healthfirst QHP	$2.28
Rate for Payer: Humana Medicare	$2.32
Rate for Payer: Senior Whole Health Medicare Advantage	$2.28
Rate for Payer: United Healthcare Commercial	$2.09
Rate for Payer: United Healthcare Medicare Advantage	$2.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.82
Rate for Payer: Wellcare Medicare	$2.17

PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT [125430]

Facility

$3.58

Service Code	HCPCS J7168
Hospital Charge Code	63833038702
Hospital Revenue Code	278
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1.79

PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT [125430]

Facility

$3.58

Service Code	HCPCS J7168
Hospital Charge Code	63833038702
Hospital Revenue Code	278
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$2.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.28
Rate for Payer: Aetna Government	$2.28
Rate for Payer: Brighton Health Commercial	$2.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Elderplan Medicare Advantage	$2.28
Rate for Payer: EmblemHealth Commercial	$1.79
Rate for Payer: Fidelis Medicare Advantage	$2.28
Rate for Payer: Group Health Inc Commercial	$2.28
Rate for Payer: Group Health Inc Medicare	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1.79
Rate for Payer: Healthfirst Medicare Advantage	$1.94
Rate for Payer: Healthfirst QHP	$2.28
Rate for Payer: Humana Medicare	$2.32
Rate for Payer: Senior Whole Health Medicare Advantage	$2.28
Rate for Payer: United Healthcare Medicare Advantage	$2.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.82

PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT [122122]

Facility

$3.58

Service Code	HCPCS J7168
Hospital Charge Code	63833038602
Hospital Revenue Code	278
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1.79

PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT [122122]

Facility

$3.58

Service Code	HCPCS J7168
Hospital Charge Code	63833038602
Hospital Revenue Code	278
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$2.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.28
Rate for Payer: Aetna Government	$2.28
Rate for Payer: Brighton Health Commercial	$2.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Elderplan Medicare Advantage	$2.28
Rate for Payer: EmblemHealth Commercial	$1.79
Rate for Payer: Fidelis Medicare Advantage	$2.28
Rate for Payer: Group Health Inc Commercial	$2.28
Rate for Payer: Group Health Inc Medicare	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1.79
Rate for Payer: Healthfirst Medicare Advantage	$1.94
Rate for Payer: Healthfirst QHP	$2.28
Rate for Payer: Humana Medicare	$2.32
Rate for Payer: Senior Whole Health Medicare Advantage	$2.28
Rate for Payer: United Healthcare Medicare Advantage	$2.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.82

PROTHROMBIN COMPL HUMAN 1000 UNIT

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41646496
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Cash Price	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76

PROTHROMBIN COMPL HUMAN 1000 UNIT

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41656496
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.28
Rate for Payer: Aetna Government	$2.28
Rate for Payer: Affinity Essential Plan 1&2	$1.60
Rate for Payer: Affinity Essential Plan 3&4	$1.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.60
Rate for Payer: Brighton Health Commercial	$2.11
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cash Price	$2.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.02
Rate for Payer: Elderplan Medicare Advantage	$2.28
Rate for Payer: EmblemHealth Commercial	$2.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.28
Rate for Payer: Fidelis Essential Plan Aliesa	$2.28
Rate for Payer: Fidelis Essential Plan QHP	$2.39
Rate for Payer: Fidelis Medicare Advantage	$2.28
Rate for Payer: Fidelis Qualified Health Plan	$2.39
Rate for Payer: Group Health Inc Commercial	$2.28
Rate for Payer: Group Health Inc Medicare	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: Healthfirst Medicare Advantage	$1.94
Rate for Payer: Healthfirst QHP	$2.28
Rate for Payer: Humana Medicare	$2.32
Rate for Payer: Senior Whole Health Medicare Advantage	$2.28
Rate for Payer: United Healthcare Commercial	$2.09
Rate for Payer: United Healthcare Medicare Advantage	$2.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.82
Rate for Payer: Wellcare Medicare	$2.17

PROTHROMBIN COMPL HUMAN 1000 UNIT

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41656496
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Cash Price	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76

PROTHROMBIN COMPL HUMAN 1000 UNIT

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41646496
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.28
Rate for Payer: Aetna Government	$2.28
Rate for Payer: Affinity Essential Plan 1&2	$1.60
Rate for Payer: Affinity Essential Plan 3&4	$1.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.60
Rate for Payer: Brighton Health Commercial	$2.11
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cash Price	$2.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.02
Rate for Payer: Elderplan Medicare Advantage	$2.28
Rate for Payer: EmblemHealth Commercial	$2.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.28
Rate for Payer: Fidelis Essential Plan Aliesa	$2.28
Rate for Payer: Fidelis Essential Plan QHP	$2.39
Rate for Payer: Fidelis Medicare Advantage	$2.28
Rate for Payer: Fidelis Qualified Health Plan	$2.39
Rate for Payer: Group Health Inc Commercial	$2.28
Rate for Payer: Group Health Inc Medicare	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: Healthfirst Medicare Advantage	$1.94
Rate for Payer: Healthfirst QHP	$2.28
Rate for Payer: Humana Medicare	$2.32
Rate for Payer: Senior Whole Health Medicare Advantage	$2.28
Rate for Payer: United Healthcare Commercial	$2.09
Rate for Payer: United Healthcare Medicare Advantage	$2.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.82
Rate for Payer: Wellcare Medicare	$2.17

PROTHROMBIN COMPL HUMAN 500 UNITS

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41656495
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.28
Rate for Payer: Aetna Government	$2.28
Rate for Payer: Affinity Essential Plan 1&2	$1.60
Rate for Payer: Affinity Essential Plan 3&4	$1.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.60
Rate for Payer: Brighton Health Commercial	$2.11
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cash Price	$2.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.02
Rate for Payer: Elderplan Medicare Advantage	$2.28
Rate for Payer: EmblemHealth Commercial	$2.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.28
Rate for Payer: Fidelis Essential Plan Aliesa	$2.28
Rate for Payer: Fidelis Essential Plan QHP	$2.39
Rate for Payer: Fidelis Medicare Advantage	$2.28
Rate for Payer: Fidelis Qualified Health Plan	$2.39
Rate for Payer: Group Health Inc Commercial	$2.28
Rate for Payer: Group Health Inc Medicare	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76
Rate for Payer: Healthfirst Medicare Advantage	$1.94
Rate for Payer: Healthfirst QHP	$2.28
Rate for Payer: Humana Medicare	$2.32
Rate for Payer: Senior Whole Health Medicare Advantage	$2.28
Rate for Payer: United Healthcare Commercial	$2.09
Rate for Payer: United Healthcare Medicare Advantage	$2.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.82
Rate for Payer: Wellcare Medicare	$2.17

PROTHROMBIN COMPL HUMAN 500 UNITS

Facility

$3.52

Service Code	HCPCS J7168
Hospital Charge Code	41656495
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Cash Price	$2.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1.76

PROTHROMBIN GENE ANALYSI

Facility

$164.23

Service Code	HCPCS 81240
Hospital Charge Code	30305801
Hospital Revenue Code	310
Min. Negotiated Rate	$45.98
Max. Negotiated Rate	$131.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.69
Rate for Payer: Aetna Government	$65.69
Rate for Payer: Affinity Essential Plan 1&2	$45.98
Rate for Payer: Affinity Essential Plan 3&4	$45.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$45.98
Rate for Payer: Brighton Health Commercial	$65.69
Rate for Payer: Cash Price	$65.69
Rate for Payer: Cash Price	$65.69
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$65.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$131.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.68
Rate for Payer: Elderplan Medicare Advantage	$65.69
Rate for Payer: EmblemHealth Commercial	$65.69
Rate for Payer: Fidelis Essential Plan Aliesa	$55.84
Rate for Payer: Fidelis Essential Plan QHP	$58.46
Rate for Payer: Fidelis Medicare Advantage	$65.69
Rate for Payer: Fidelis Qualified Health Plan	$58.46
Rate for Payer: Group Health Inc Commercial	$65.69
Rate for Payer: Group Health Inc Medicare	$65.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.12
Rate for Payer: Hamaspik Choice Inc Medicare	$65.69
Rate for Payer: Healthfirst Medicare Advantage	$65.69
Rate for Payer: Healthfirst QHP	$65.69
Rate for Payer: Humana Medicare	$67.00
Rate for Payer: Senior Whole Health Medicare Advantage	$65.69
Rate for Payer: United Healthcare Medicare Advantage	$65.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52.55
Rate for Payer: Wellcare Medicare	$59.12

PROTHROMBIN GENE ANALYSI

Facility

$164.23

Service Code	HCPCS 81240
Hospital Charge Code	30305801
Hospital Revenue Code	310
Rate for Payer: Cash Price	$65.69

PROTHROMBIN TIME

Facility

$10.73

Service Code	HCPCS 85610
Hospital Charge Code	40621566
Hospital Revenue Code	300
Rate for Payer: Cash Price	$4.29

PROTHROMBIN TIME

Facility

$10.73

Service Code	HCPCS 85610
Hospital Charge Code	40621566
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$8.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.29
Rate for Payer: Aetna Government	$4.29
Rate for Payer: Affinity Essential Plan 1&2	$3.00
Rate for Payer: Affinity Essential Plan 3&4	$3.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.00
Rate for Payer: Brighton Health Commercial	$8.05
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cash Price	$4.29
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.28
Rate for Payer: Elderplan Medicare Advantage	$4.29
Rate for Payer: EmblemHealth Commercial	$4.29
Rate for Payer: Fidelis Essential Plan Aliesa	$3.65
Rate for Payer: Fidelis Essential Plan QHP	$3.82
Rate for Payer: Fidelis Medicare Advantage	$4.29
Rate for Payer: Fidelis Qualified Health Plan	$3.82
Rate for Payer: Group Health Inc Commercial	$4.29
Rate for Payer: Group Health Inc Medicare	$4.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.36
Rate for Payer: Hamaspik Choice Inc Medicare	$4.29
Rate for Payer: Healthfirst Medicare Advantage	$4.29
Rate for Payer: Healthfirst QHP	$4.29
Rate for Payer: Humana Medicare	$4.38
Rate for Payer: Senior Whole Health Medicare Advantage	$4.29
Rate for Payer: United Healthcare Commercial	$4.98
Rate for Payer: United Healthcare Medicare Advantage	$4.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.43
Rate for Payer: Wellcare Medicare	$3.86

PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA

Professional

Both

$388.99

Service Code	HCPCS 92502
Min. Negotiated Rate	$291.74
Max. Negotiated Rate	$291.74
Rate for Payer: Cash Price	$107.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$291.74
Rate for Payer: SOMOS Essential	$291.74

PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ

Professional

Both

$2,021.60

Service Code	HCPCS 69300
Min. Negotiated Rate	$1,516.20
Max. Negotiated Rate	$1,516.20
Rate for Payer: Cash Price	$552.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,516.20
Rate for Payer: SOMOS Essential	$1,516.20

Know your out-of-pocket cost for care.

All Charges