St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RASBURICASE 7.5MG/1ML

Facility

$383.21

Service Code	HCPCS J2783
Hospital Charge Code	41650292
Hospital Revenue Code	636
Min. Negotiated Rate	$191.60
Max. Negotiated Rate	$389.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$367.27
Rate for Payer: Aetna Government	$367.27
Rate for Payer: Affinity Essential Plan 1&2	$257.09
Rate for Payer: Affinity Essential Plan 3&4	$257.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$257.09
Rate for Payer: Brighton Health Commercial	$229.93
Rate for Payer: Cash Price	$367.27
Rate for Payer: Cash Price	$367.27
Rate for Payer: Cash Price	$367.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$367.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.35
Rate for Payer: Elderplan Medicare Advantage	$367.27
Rate for Payer: EmblemHealth Commercial	$367.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$367.27
Rate for Payer: Fidelis Essential Plan Aliesa	$367.27
Rate for Payer: Fidelis Essential Plan QHP	$385.63
Rate for Payer: Fidelis Medicare Advantage	$367.27
Rate for Payer: Fidelis Qualified Health Plan	$385.63
Rate for Payer: Group Health Inc Commercial	$367.27
Rate for Payer: Group Health Inc Medicare	$367.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.60
Rate for Payer: Hamaspik Choice Inc Medicare	$191.60
Rate for Payer: Healthfirst Medicare Advantage	$312.18
Rate for Payer: Healthfirst QHP	$367.27
Rate for Payer: Humana Medicare	$374.61
Rate for Payer: Senior Whole Health Medicare Advantage	$367.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$389.53
Rate for Payer: SOMOS Essential	$389.53
Rate for Payer: United Healthcare Commercial	$340.86
Rate for Payer: United Healthcare Medicare Advantage	$367.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$249.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$293.81
Rate for Payer: Wellcare Medicare	$348.90

RASBURICASE 7.5MG/1ML

Facility

$383.21

Service Code	HCPCS J2783
Hospital Charge Code	41640292
Hospital Revenue Code	636
Min. Negotiated Rate	$191.60
Max. Negotiated Rate	$191.60
Rate for Payer: Cash Price	$367.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.60
Rate for Payer: Hamaspik Choice Inc Medicare	$191.60

RASBURICASE 7.5MG/1ML

Facility

$383.21

Service Code	HCPCS J2783
Hospital Charge Code	41640292
Hospital Revenue Code	636
Min. Negotiated Rate	$191.60
Max. Negotiated Rate	$389.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$367.27
Rate for Payer: Aetna Government	$367.27
Rate for Payer: Affinity Essential Plan 1&2	$257.09
Rate for Payer: Affinity Essential Plan 3&4	$257.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$257.09
Rate for Payer: Brighton Health Commercial	$229.93
Rate for Payer: Cash Price	$367.27
Rate for Payer: Cash Price	$367.27
Rate for Payer: Cash Price	$367.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$367.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.35
Rate for Payer: Elderplan Medicare Advantage	$367.27
Rate for Payer: EmblemHealth Commercial	$367.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$367.27
Rate for Payer: Fidelis Essential Plan Aliesa	$367.27
Rate for Payer: Fidelis Essential Plan QHP	$385.63
Rate for Payer: Fidelis Medicare Advantage	$367.27
Rate for Payer: Fidelis Qualified Health Plan	$385.63
Rate for Payer: Group Health Inc Commercial	$367.27
Rate for Payer: Group Health Inc Medicare	$367.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.60
Rate for Payer: Hamaspik Choice Inc Medicare	$191.60
Rate for Payer: Healthfirst Medicare Advantage	$312.18
Rate for Payer: Healthfirst QHP	$367.27
Rate for Payer: Humana Medicare	$374.61
Rate for Payer: Senior Whole Health Medicare Advantage	$367.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$389.53
Rate for Payer: SOMOS Essential	$389.53
Rate for Payer: United Healthcare Commercial	$340.86
Rate for Payer: United Healthcare Medicare Advantage	$367.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$249.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$293.81
Rate for Payer: Wellcare Medicare	$348.90

RASBURICASE 7.5MG/1ML

Facility

$383.21

Service Code	HCPCS J2783
Hospital Charge Code	41650292
Hospital Revenue Code	636
Min. Negotiated Rate	$191.60
Max. Negotiated Rate	$191.60
Rate for Payer: Cash Price	$367.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.60
Rate for Payer: Hamaspik Choice Inc Medicare	$191.60

RASBURICASE 7.5 MG IV SOLR [76868]

Facility

$6,447.08

Service Code	HCPCS J2783
Hospital Charge Code	00024515175
Hospital Revenue Code	278
Min. Negotiated Rate	$3,223.54
Max. Negotiated Rate	$3,223.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,223.54
Rate for Payer: Hamaspik Choice Inc Medicare	$3,223.54

RASBURICASE 7.5 MG IV SOLR [76868]

Facility

$6,447.08

Service Code	HCPCS J2783
Hospital Charge Code	00024515175
Hospital Revenue Code	278
Min. Negotiated Rate	$293.81
Max. Negotiated Rate	$4,190.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,545.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$367.27
Rate for Payer: Aetna Government	$367.27
Rate for Payer: Brighton Health Commercial	$3,868.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$367.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,223.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,707.07
Rate for Payer: Elderplan Medicare Advantage	$367.27
Rate for Payer: EmblemHealth Commercial	$3,223.54
Rate for Payer: Fidelis Medicare Advantage	$367.27
Rate for Payer: Group Health Inc Commercial	$367.27
Rate for Payer: Group Health Inc Medicare	$367.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,223.54
Rate for Payer: Hamaspik Choice Inc Medicare	$3,223.54
Rate for Payer: Healthfirst Medicare Advantage	$312.18
Rate for Payer: Healthfirst QHP	$367.27
Rate for Payer: Humana Medicare	$374.61
Rate for Payer: Senior Whole Health Medicare Advantage	$367.27
Rate for Payer: United Healthcare Medicare Advantage	$367.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,190.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$293.81

RASP SMALL BONE 13.5X5.5MM

Facility

$202.85

Hospital Charge Code	64904719
Hospital Revenue Code	270
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$162.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$111.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$101.42
Rate for Payer: Aetna Government	$101.42
Rate for Payer: Brighton Health Commercial	$152.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$162.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$137.94
Rate for Payer: Group Health Inc Commercial	$101.42
Rate for Payer: Group Health Inc Medicare	$71.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$101.42
Rate for Payer: Hamaspik Choice Inc Medicare	$101.42

RASP TEAR CROSSCUT

Facility

$155.25

Hospital Charge Code	64903072
Hospital Revenue Code	270
Min. Negotiated Rate	$54.34
Max. Negotiated Rate	$124.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.62
Rate for Payer: Aetna Government	$77.62
Rate for Payer: Brighton Health Commercial	$116.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.57
Rate for Payer: Group Health Inc Commercial	$77.62
Rate for Payer: Group Health Inc Medicare	$54.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.62
Rate for Payer: Hamaspik Choice Inc Medicare	$77.62

RASP TEAR SHAPE 12.5 X 7MM

Facility

$130.83

Hospital Charge Code	64904721
Hospital Revenue Code	270
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$104.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.42
Rate for Payer: Aetna Government	$65.42
Rate for Payer: Brighton Health Commercial	$98.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$88.96
Rate for Payer: Group Health Inc Commercial	$65.42
Rate for Payer: Group Health Inc Medicare	$45.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.42
Rate for Payer: Hamaspik Choice Inc Medicare	$65.42

RA TREATMENT DELIVERY,> MEV,SIMP

Facility

$371.65

Service Code	HCPCS 77402
Hospital Charge Code	66541227
Hospital Revenue Code	333
Rate for Payer: Cash Price	$138.67

RA TREATMENT DELIVERY,> MEV,SIMP

Facility

$371.65

Service Code	HCPCS 77402
Hospital Charge Code	66541227
Hospital Revenue Code	333
Min. Negotiated Rate	$97.07
Max. Negotiated Rate	$297.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$138.67
Rate for Payer: Aetna Government	$138.67
Rate for Payer: Affinity Essential Plan 1&2	$97.07
Rate for Payer: Affinity Essential Plan 3&4	$97.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$97.07
Rate for Payer: Brighton Health Commercial	$278.74
Rate for Payer: Cash Price	$138.67
Rate for Payer: Cash Price	$138.67
Rate for Payer: Cash Price	$138.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$138.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$297.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.72
Rate for Payer: Elderplan Medicare Advantage	$138.67
Rate for Payer: EmblemHealth Commercial	$138.67
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 Medicare Advantage	$138.67
Rate for Payer: Fidelis Qualified Health Plan	$294.00
Rate for Payer: Group Health Inc Commercial	$138.67
Rate for Payer: Group Health Inc Medicare	$138.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.82
Rate for Payer: Hamaspik Choice Inc Medicare	$138.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$124.80
Rate for Payer: Healthfirst Medicare Advantage	$138.67
Rate for Payer: Healthfirst QHP	$138.67
Rate for Payer: Humana Medicare	$141.44
Rate for Payer: Senior Whole Health Medicare Advantage	$138.67
Rate for Payer: United Healthcare Medicare Advantage	$138.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$138.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$110.94
Rate for Payer: Wellcare Medicare	$131.74

RAZOR BLADES

Facility

$9.57

Hospital Charge Code	40205350
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.79
Rate for Payer: Aetna Government	$4.79
Rate for Payer: Brighton Health Commercial	$7.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.51
Rate for Payer: Group Health Inc Commercial	$4.79
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.79
Rate for Payer: Hamaspik Choice Inc Medicare	$4.79

RC50-LEUKOCYTE FILTER CHRG & STAT

Facility

$31.65

Service Code	HCPCS 86590
Hospital Charge Code	40701186
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.66

RC50-LEUKOCYTE FILTER CHRG & STAT

Facility

$31.65

Service Code	HCPCS 86590
Hospital Charge Code	40701186
Hospital Revenue Code	302
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$23.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.66
Rate for Payer: Aetna Government	$12.66
Rate for Payer: Affinity Essential Plan 1&2	$8.86
Rate for Payer: Affinity Essential Plan 3&4	$8.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.86
Rate for Payer: Brighton Health Commercial	$23.74
Rate for Payer: Cash Price	$12.66
Rate for Payer: Cash Price	$12.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.84
Rate for Payer: Elderplan Medicare Advantage	$12.66
Rate for Payer: EmblemHealth Commercial	$12.66
Rate for Payer: Fidelis Essential Plan Aliesa	$10.76
Rate for Payer: Fidelis Essential Plan QHP	$11.27
Rate for Payer: Fidelis Medicare Advantage	$12.66
Rate for Payer: Fidelis Qualified Health Plan	$11.27
Rate for Payer: Group Health Inc Commercial	$12.66
Rate for Payer: Group Health Inc Medicare	$12.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.82
Rate for Payer: Hamaspik Choice Inc Medicare	$12.66
Rate for Payer: Healthfirst Medicare Advantage	$12.66
Rate for Payer: Healthfirst QHP	$12.66
Rate for Payer: Humana Medicare	$12.91
Rate for Payer: Senior Whole Health Medicare Advantage	$12.66
Rate for Payer: United Healthcare Commercial	$13.98
Rate for Payer: United Healthcare Medicare Advantage	$12.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.13
Rate for Payer: Wellcare Medicare	$11.39

RCFW-5.0-35 SHORT INTRO SHEATH

Facility

$71.00

Hospital Charge Code	64905026
Hospital Revenue Code	270
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$56.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.50
Rate for Payer: Aetna Government	$35.50
Rate for Payer: Brighton Health Commercial	$53.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.28
Rate for Payer: Group Health Inc Commercial	$35.50
Rate for Payer: Group Health Inc Medicare	$24.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.50
Rate for Payer: Hamaspik Choice Inc Medicare	$35.50

RCT 4 CANALS

Facility

$855.81

Hospital Charge Code	42300725
Hospital Revenue Code	361
Min. Negotiated Rate	$299.53
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$470.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$427.90
Rate for Payer: Aetna Government	$427.90
Rate for Payer: Brighton Health Commercial	$641.86
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	$427.90
Rate for Payer: Group Health Inc Medicare	$299.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$427.90
Rate for Payer: Hamaspik Choice Inc Medicare	$427.90

RD PROH CRYO

Facility

$819.25

Service Code	HCPCS 67141
Hospital Charge Code	40074312
Hospital Revenue Code	360
Min. Negotiated Rate	$235.82
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$336.88
Rate for Payer: Aetna Government	$336.88
Rate for Payer: Affinity Essential Plan 1&2	$235.82
Rate for Payer: Affinity Essential Plan 3&4	$235.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$235.82
Rate for Payer: Brighton Health Commercial	$614.44
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Cash Price	$336.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$336.88
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	$336.88
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$286.35
Rate for Payer: Fidelis Essential Plan QHP	$299.82
Rate for Payer: Fidelis Medicare Advantage	$336.88
Rate for Payer: Fidelis Qualified Health Plan	$299.82
Rate for Payer: Group Health Inc Commercial	$336.88
Rate for Payer: Group Health Inc Medicare	$336.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$409.62
Rate for Payer: Hamaspik Choice Inc Medicare	$336.88
Rate for Payer: Healthfirst Medicare Advantage	$286.35
Rate for Payer: Healthfirst QHP	$336.88
Rate for Payer: Humana Medicare	$343.62
Rate for Payer: Senior Whole Health Medicare Advantage	$336.88
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$336.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$336.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$269.50
Rate for Payer: Wellcare Medicare	$320.04

RD PROH CRYO

Facility

$819.25

Service Code	HCPCS 67141
Hospital Charge Code	40074312
Hospital Revenue Code	360
Rate for Payer: Cash Price	$336.88

RD PROH LASER

Facility

$1,535.38

Service Code	HCPCS 67145
Hospital Charge Code	40074313
Hospital Revenue Code	360
Rate for Payer: Cash Price	$672.19

RD PROH LASER

Facility

$1,535.38

Service Code	HCPCS 67145
Hospital Charge Code	30302037
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$672.19
Rate for Payer: Aetna Government	$672.19
Rate for Payer: Affinity Essential Plan 1&2	$470.53
Rate for Payer: Affinity Essential Plan 3&4	$470.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$470.53
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$672.19
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	$672.19
Rate for Payer: Fidelis Essential Plan Aliesa	$571.36
Rate for Payer: Fidelis Essential Plan QHP	$598.25
Rate for Payer: Fidelis Medicare Advantage	$672.19
Rate for Payer: Fidelis Qualified Health Plan	$598.25
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	$767.69
Rate for Payer: Hamaspik Choice Inc Medicare	$672.19
Rate for Payer: Healthfirst Medicare Advantage	$571.36
Rate for Payer: Healthfirst QHP	$672.19
Rate for Payer: Humana Medicare	$685.63
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$672.19
Rate for Payer: Senior Whole Health Medicare Advantage	$672.19
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$672.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$672.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$537.75
Rate for Payer: Wellcare Medicare	$638.58

RD PROH LASER

Facility

$1,535.38

Service Code	HCPCS 67145
Hospital Charge Code	40074313
Hospital Revenue Code	360
Min. Negotiated Rate	$470.53
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$672.19
Rate for Payer: Aetna Government	$672.19
Rate for Payer: Affinity Essential Plan 1&2	$470.53
Rate for Payer: Affinity Essential Plan 3&4	$470.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$470.53
Rate for Payer: Brighton Health Commercial	$1,151.54
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$672.19
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	$672.19
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$571.36
Rate for Payer: Fidelis Essential Plan QHP	$598.25
Rate for Payer: Fidelis Medicare Advantage	$672.19
Rate for Payer: Fidelis Qualified Health Plan	$598.25
Rate for Payer: Group Health Inc Commercial	$672.19
Rate for Payer: Group Health Inc Medicare	$672.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$767.69
Rate for Payer: Hamaspik Choice Inc Medicare	$672.19
Rate for Payer: Healthfirst Medicare Advantage	$571.36
Rate for Payer: Healthfirst QHP	$672.19
Rate for Payer: Humana Medicare	$685.63
Rate for Payer: Senior Whole Health Medicare Advantage	$672.19
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$672.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$672.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$537.75
Rate for Payer: Wellcare Medicare	$638.58

RD PROH LASER

Facility

$1,535.38

Service Code	HCPCS 67145
Hospital Charge Code	30302037
Hospital Revenue Code	510
Rate for Payer: Cash Price	$672.19

READING EVALUATION

Facility

$318.94

Hospital Charge Code	41904864
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$159.47
Rate for Payer: Aetna Government	$159.47
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$159.47
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.47
Rate for Payer: Hamaspik Choice Inc Medicare	$159.47
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

READING/LD THERAPY GRP 15-30 MIN.

Facility

$63.79

Hospital Charge Code	41904874
Hospital Revenue Code	440
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.89
Rate for Payer: Aetna Government	$31.89
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$31.89
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.89
Rate for Payer: Hamaspik Choice Inc Medicare	$31.89
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

READING/LD THERAPY GRP 31-45 MIN.

Facility

$85.05

Hospital Charge Code	41904875
Hospital Revenue Code	440
Min. Negotiated Rate	$42.52
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.52
Rate for Payer: Aetna Government	$42.52
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$42.52
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.52
Rate for Payer: Hamaspik Choice Inc Medicare	$42.52
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

Know your out-of-pocket cost for care.

All Charges