St. Barnabas Hospital

All Charges

Charge

Type

Price

SP CAROTID LIMITED

Facility OP

$339.45

Service Code	HCPCS 93882 TC
Hospital Charge Code	41201161
Hospital Revenue Code	920
Min. Negotiated Rate	$111.93
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$111.93
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$124.37

SP CATHETERIZATION HEPATIC VEIN

Facility OP

$2,814.83

Service Code	HCPCS 36011 TC
Hospital Charge Code	41547723
Hospital Revenue Code	361
Min. Negotiated Rate	$985.19
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,548.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,407.42
Rate for Payer: Aetna Government	$1,407.42
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	$1,407.42
Rate for Payer: Group Health Inc Medicare	$985.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,407.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1,407.42

SP CATH PLAC/PICC/SHIL

Facility OP

$4,940.28

Service Code	HCPCS 36555 TC
Hospital Charge Code	41542835
Hospital Revenue Code	361
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
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	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

SP CAVERNOSOGRAM

Facility OP

$295.08

Service Code	HCPCS 54230 TC
Hospital Charge Code	41547454
Hospital Revenue Code	361
Min. Negotiated Rate	$103.28
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$162.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$147.54
Rate for Payer: Aetna Government	$147.54
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	$147.54
Rate for Payer: Group Health Inc Medicare	$103.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.54
Rate for Payer: Hamaspik Choice Inc Medicare	$147.54

SP CELIAC PLEXUS BLOCK

Facility OP

$2,459.50

Service Code	HCPCS 64530 TC
Hospital Charge Code	41561842
Hospital Revenue Code	361
Min. Negotiated Rate	$860.82
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,352.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,229.75
Rate for Payer: Aetna Government	$1,229.75
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
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	$1,229.75
Rate for Payer: Group Health Inc Medicare	$860.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,229.75

SP CEN LINE EXCH

Facility OP

$4,940.28

Service Code	HCPCS 36580 TC
Hospital Charge Code	41549844
Hospital Revenue Code	361
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
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	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

SP CESSATION AT/VEN THROMB THER

Facility OP

$4,940.28

Service Code	HCPCS 37214 TC
Hospital Charge Code	41543303
Hospital Revenue Code	329
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
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	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

SP CHANGE CYSTOSTOMY TUBE

Facility OP

$711.45

Service Code	HCPCS 51705 TC
Hospital Charge Code	41547645
Hospital Revenue Code	361
Min. Negotiated Rate	$249.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$391.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$355.72
Rate for Payer: Aetna Government	$355.72
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
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	$355.72
Rate for Payer: Group Health Inc Medicare	$249.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$355.72

SP CHANGE CYSTOSTOMY TUBE COMPLIC

Facility OP

$1,685.60

Service Code	HCPCS 51710 TC
Hospital Charge Code	41549906
Hospital Revenue Code	361
Min. Negotiated Rate	$589.96
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$927.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$842.80
Rate for Payer: Aetna Government	$842.80
Rate for Payer: Cash Price	$789.96
Rate for Payer: Cash Price	$789.96
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	$842.80
Rate for Payer: Group Health Inc Medicare	$589.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$842.80
Rate for Payer: Hamaspik Choice Inc Medicare	$842.80

SP CHANGE GASTRO TUBE

Facility OP

$711.45

Service Code	HCPCS 43763 TC
Hospital Charge Code	41542707
Hospital Revenue Code	361
Min. Negotiated Rate	$249.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$391.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$355.72
Rate for Payer: Aetna Government	$355.72
Rate for Payer: Cash Price	$285.81
Rate for Payer: Cash Price	$285.81
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	$355.72
Rate for Payer: Group Health Inc Medicare	$249.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.72
Rate for Payer: Hamaspik Choice Inc Medicare	$355.72

SP CHANGE INT/EXT N-U

Facility OP

$5,365.58

Service Code	HCPCS 50387 TC
Hospital Charge Code	41548032
Hospital Revenue Code	361
Min. Negotiated Rate	$1,877.95
Max. Negotiated Rate	$2,951.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
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	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79

SP CHANGE URETEROSTOMY CATH

Facility OP

$5,365.58

Service Code	HCPCS 50688 TC
Hospital Charge Code	41547639
Hospital Revenue Code	361
Min. Negotiated Rate	$1,877.95
Max. Negotiated Rate	$2,951.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
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	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79

SP CHANGE URTRLSTNT 1/EA/CONDUIT

Facility OP

$5,365.58

Service Code	HCPCS 50688 TC
Hospital Charge Code	41548034
Hospital Revenue Code	361
Min. Negotiated Rate	$1,877.95
Max. Negotiated Rate	$2,951.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
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	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79

SP CHEMOTHERAPY IA ADMINISRATION

Facility OP

$937.70

Service Code	HCPCS 96420 TC
Hospital Charge Code	41547638
Hospital Revenue Code	331
Min. Negotiated Rate	$279.92
Max. Negotiated Rate	$644.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$515.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$468.85
Rate for Payer: Aetna Government	$468.85
Rate for Payer: Cash Price	$391.64
Rate for Payer: Cash Price	$391.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$644.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$547.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$279.92
Rate for Payer: Fidelis Essential Plan Aliesa	$279.92
Rate for Payer: Fidelis Essential Plan QHP	$294.00
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$468.85
Rate for Payer: Group Health Inc Medicare	$328.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$468.85
Rate for Payer: Hamaspik Choice Inc Medicare	$468.85

SP CHEST TUBE ABSCESS HEMOTHORAX

Facility OP

$4,940.28

Service Code	HCPCS 32551 TC
Hospital Charge Code	41561811
Hospital Revenue Code	361
Min. Negotiated Rate	$1,729.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
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	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14

SP CHOLEDOCHAL STENT PLACE.

Facility OP

$2,807.50

Service Code	HCPCS 47801 TC
Hospital Charge Code	41547452
Hospital Revenue Code	361
Min. Negotiated Rate	$982.62
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,544.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,403.75
Rate for Payer: Aetna Government	$1,403.75
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	$1,403.75
Rate for Payer: Group Health Inc Medicare	$982.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,403.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,403.75

SP COMMON CARTID ARTY CATHER UNI

Facility OP

$13,920.70

Service Code	HCPCS 36223 TC
Hospital Charge Code	41103009
Hospital Revenue Code	329
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$7,656.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,656.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,960.35
Rate for Payer: Aetna Government	$6,960.35
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Cash Price	$6,354.94
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	$6,960.35
Rate for Payer: Group Health Inc Medicare	$4,872.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.35
Rate for Payer: Hamaspik Choice Inc Medicare	$6,960.35

SP COMMON FEMORAL, INSILATERAL

Facility OP

$1,475.15

Service Code	HCPCS 36140 TC
Hospital Charge Code	41542826
Hospital Revenue Code	361
Min. Negotiated Rate	$516.30
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$811.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$737.58
Rate for Payer: Aetna Government	$737.58
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	$737.58
Rate for Payer: Group Health Inc Medicare	$516.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$737.58
Rate for Payer: Hamaspik Choice Inc Medicare	$737.58

SP COMPLETE PENILE

Facility OP

$339.45

Service Code	HCPCS 93980 TC
Hospital Charge Code	41201176
Hospital Revenue Code	920
Min. Negotiated Rate	$63.91
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63.91
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71.01

SP COMP REN/MESE/POR ABD

Facility OP

$705.83

Service Code	HCPCS 93975 TC
Hospital Charge Code	41201172
Hospital Revenue Code	920
Min. Negotiated Rate	$235.69
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$235.69
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$261.88

SP CONSC. SEDAT. AGE<5 1ST 30 MIN

Facility OP

$4,157.25

Service Code	HCPCS 99143
Hospital Charge Code	30102476
Hospital Revenue Code	370
Min. Negotiated Rate	$1,455.04
Max. Negotiated Rate	$3,325.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,286.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,078.62
Rate for Payer: Aetna Government	$2,078.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,325.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,826.93
Rate for Payer: Group Health Inc Commercial	$2,078.62
Rate for Payer: Group Health Inc Medicare	$1,455.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,078.62

SP CONSC. SEDAT. AGE<5 1ST 30 MIN

Facility OP

$84.10

Service Code	HCPCS 99151 TC
Hospital Charge Code	41548613
Hospital Revenue Code	372
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$67.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.05
Rate for Payer: Aetna Government	$42.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.19
Rate for Payer: Group Health Inc Commercial	$42.05
Rate for Payer: Group Health Inc Medicare	$29.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.05
Rate for Payer: Hamaspik Choice Inc Medicare	$42.05

SP CONSC. SEDAT. AGE>5 1ST 30 MIN

Facility OP

$792.83

Service Code	HCPCS 99144
Hospital Charge Code	30102472
Hospital Revenue Code	370
Min. Negotiated Rate	$277.49
Max. Negotiated Rate	$634.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$436.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$396.42
Rate for Payer: Aetna Government	$396.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$634.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$539.12
Rate for Payer: Group Health Inc Commercial	$396.42
Rate for Payer: Group Health Inc Medicare	$277.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$396.42

SP CONSC. SEDAT. AGE>5 1ST 30 MIN

Facility OP

$84.10

Service Code	HCPCS 99152 TC
Hospital Charge Code	41548612
Hospital Revenue Code	370
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$67.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.05
Rate for Payer: Aetna Government	$42.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.19
Rate for Payer: Group Health Inc Commercial	$42.05
Rate for Payer: Group Health Inc Medicare	$29.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.05
Rate for Payer: Hamaspik Choice Inc Medicare	$42.05

SP CONSC. SEDAT. EACH ADD'L 15MIN

Facility OP

$42.05

Service Code	HCPCS 99153 TC
Hospital Charge Code	41548614
Hospital Revenue Code	370
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$33.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.02
Rate for Payer: Aetna Government	$21.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.59
Rate for Payer: Group Health Inc Commercial	$21.02
Rate for Payer: Group Health Inc Medicare	$14.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.02
Rate for Payer: Hamaspik Choice Inc Medicare	$21.02

Price Transparency.

All Charges