St. Barnabas Hospital

All Charges

Charge

Type

Price

US OBGYN DETAILED ADDL FETUS

Facility OP

$595.93

Service Code	HCPCS 76812 TC
Hospital Charge Code	41301501
Hospital Revenue Code	402
Min. Negotiated Rate	$120.43
Max. Negotiated Rate	$476.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$327.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$297.96
Rate for Payer: Aetna Government	$297.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$476.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$405.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$120.43
Rate for Payer: Group Health Inc Commercial	$297.96
Rate for Payer: Group Health Inc Medicare	$208.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$297.96
Rate for Payer: Hamaspik Choice Inc Medicare	$297.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$133.81

US OBGYN DETAILED SNGL FETUS

Facility OP

$705.83

Service Code	HCPCS 76811 TC
Hospital Charge Code	41301500
Hospital Revenue Code	402
Min. Negotiated Rate	$97.07
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	$97.07
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	$107.86

US OBGYN ECHO GUI FOR AMNIO

Facility OP

$453.64

Service Code	HCPCS 76946 TC
Hospital Charge Code	41309826
Hospital Revenue Code	402
Min. Negotiated Rate	$16.60
Max. Negotiated Rate	$362.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.82
Rate for Payer: Aetna Government	$226.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$362.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16.60
Rate for Payer: Group Health Inc Commercial	$226.82
Rate for Payer: Group Health Inc Medicare	$158.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.82
Rate for Payer: Hamaspik Choice Inc Medicare	$226.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18.44

US OBGYN MIDDLE CEREB ARTERY ECHO

Facility OP

$339.45

Service Code	HCPCS 76821 TC
Hospital Charge Code	41301507
Hospital Revenue Code	402
Min. Negotiated Rate	$62.06
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	$62.06
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	$68.96

US OBGYN PREG <14 WKS ADDL FETUS

Facility OP

$169.73

Service Code	HCPCS 76802 TC
Hospital Charge Code	41301505
Hospital Revenue Code	402
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$135.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.86
Rate for Payer: Aetna Government	$84.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23.66
Rate for Payer: Group Health Inc Commercial	$84.86
Rate for Payer: Group Health Inc Medicare	$59.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.86
Rate for Payer: Hamaspik Choice Inc Medicare	$84.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26.29

US OBGYN PREG >/=14WKS ADDL FETUS

Facility OP

$169.73

Service Code	HCPCS 76810 TC
Hospital Charge Code	41301506
Hospital Revenue Code	402
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$135.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.86
Rate for Payer: Aetna Government	$84.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46.54
Rate for Payer: Group Health Inc Commercial	$84.86
Rate for Payer: Group Health Inc Medicare	$59.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.86
Rate for Payer: Hamaspik Choice Inc Medicare	$84.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51.71

US OBGYN PREG 1ST TRI (<14WKS)

Facility OP

$339.45

Service Code	HCPCS 76801 TC
Hospital Charge Code	41301504
Hospital Revenue Code	402
Min. Negotiated Rate	$79.43
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	$79.43
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	$88.26

US OBGYN PREG 2ND & 3RD TRI >14WK

Facility OP

$339.45

Service Code	HCPCS 76805 TC
Hospital Charge Code	41309827
Hospital Revenue Code	402
Min. Negotiated Rate	$99.36
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	$99.36
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	$110.40

US OBGYN PREGNANCY FOLLOW UP

Facility OP

$339.45

Service Code	HCPCS 76816 TC
Hospital Charge Code	41309828
Hospital Revenue Code	402
Min. Negotiated Rate	$77.59
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	$77.59
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	$86.21

US OBGYN PREGNANCY LIMITED

Facility OP

$339.45

Service Code	HCPCS 76815 TC
Hospital Charge Code	41309829
Hospital Revenue Code	402
Min. Negotiated Rate	$56.52
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	$56.52
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	$62.80

US OB/GYN TRANSVAGINAL

Facility OP

$339.45

Service Code	HCPCS 76817 TC
Hospital Charge Code	41309830
Hospital Revenue Code	402
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

US OBGYN UMBILICAL ARTERY ECHO

Facility OP

$339.45

Service Code	HCPCS 76820 TC
Hospital Charge Code	41301502
Hospital Revenue Code	402
Min. Negotiated Rate	$23.99
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	$23.99
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	$26.66

US OB/GYN US GUIDANCE FOR AMNIOCE

Facility OP

$197.40

Service Code	HCPCS 76946 TC
Hospital Charge Code	41309831
Hospital Revenue Code	402
Min. Negotiated Rate	$16.60
Max. Negotiated Rate	$157.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$98.70
Rate for Payer: Aetna Government	$98.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$134.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16.60
Rate for Payer: Group Health Inc Commercial	$98.70
Rate for Payer: Group Health Inc Medicare	$69.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.70
Rate for Payer: Hamaspik Choice Inc Medicare	$98.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18.44

US OPH US DX B-SCAN&QUAN A-SCAN

Facility OP

$330.23

Service Code	HCPCS 76510 TC
Hospital Charge Code	41309967
Hospital Revenue Code	402
Min. Negotiated Rate	$33.98
Max. Negotiated Rate	$264.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.12
Rate for Payer: Aetna Government	$165.12
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cash Price	$147.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$264.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$224.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33.98
Rate for Payer: Group Health Inc Commercial	$165.12
Rate for Payer: Group Health Inc Medicare	$115.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.12
Rate for Payer: Hamaspik Choice Inc Medicare	$165.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.75

US OPH US DX QUAN A-SCAN ONLY

Facility OP

$339.45

Service Code	HCPCS 76511 TC
Hospital Charge Code	41309910
Hospital Revenue Code	402
Min. Negotiated Rate	$24.36
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	$24.36
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	$27.07

US PELVIC COMPLETE

Facility OP

$339.45

Service Code	HCPCS 76856 TC
Hospital Charge Code	41304018
Hospital Revenue Code	402
Min. Negotiated Rate	$81.66
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	$81.66
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	$90.73

US PELVIC LIMITED

Facility OP

$339.45

Service Code	HCPCS 76857 TC
Hospital Charge Code	41304032
Hospital Revenue Code	402
Min. Negotiated Rate	$28.43
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	$28.43
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	$31.59

US PERC. DRAIN. W/WO CATH.

Facility OP

$453.64

Service Code	HCPCS 75989 TC
Hospital Charge Code	41304062
Hospital Revenue Code	402
Min. Negotiated Rate	$64.66
Max. Negotiated Rate	$362.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$249.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$226.82
Rate for Payer: Aetna Government	$226.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$362.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$308.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64.66
Rate for Payer: Group Health Inc Commercial	$226.82
Rate for Payer: Group Health Inc Medicare	$158.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.82
Rate for Payer: Hamaspik Choice Inc Medicare	$226.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71.84

US PERI VASC UP/LOW EXT. BI

Facility OP

$705.83

Service Code	HCPCS 93970 TC
Hospital Charge Code	41307394
Hospital Revenue Code	920
Min. Negotiated Rate	$173.96
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	$173.96
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	$193.29

US PERI VASC UP/LOW EXT.UNI

Facility OP

$339.45

Service Code	HCPCS 93971 TC
Hospital Charge Code	41304014
Hospital Revenue Code	920
Min. Negotiated Rate	$109.71
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	$109.71
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	$121.90

US PREGNANCY COMPLETE

Facility OP

$339.45

Service Code	HCPCS 76805 TC
Hospital Charge Code	41304028
Hospital Revenue Code	402
Min. Negotiated Rate	$99.36
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	$99.36
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	$110.40

US PREGNANCY FOLLOW-UP

Facility OP

$339.45

Service Code	HCPCS 76816 TC
Hospital Charge Code	41304010
Hospital Revenue Code	402
Min. Negotiated Rate	$77.59
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	$77.59
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	$86.21

US PREGNANCY LIMITED

Facility OP

$339.45

Service Code	HCPCS 76815 TC
Hospital Charge Code	41304008
Hospital Revenue Code	402
Min. Negotiated Rate	$56.52
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	$56.52
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	$62.80

US PVR ARTERIES UP/LOW EXTREM

Facility OP

$419.03

Service Code	HCPCS 93923 TC
Hospital Charge Code	41307392
Hospital Revenue Code	920
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$209.52
Rate for Payer: Aetna Government	$209.52
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$335.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$284.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$118.95
Rate for Payer: Group Health Inc Commercial	$209.52
Rate for Payer: Group Health Inc Medicare	$146.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$209.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$132.17

US RETROPERITONEL COMPLETE

Facility OP

$339.45

Service Code	HCPCS 76770 TC
Hospital Charge Code	41304024
Hospital Revenue Code	402
Min. Negotiated Rate	$82.76
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	$82.76
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	$91.96

Price Transparency.

All Charges