St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TAP SPINE

Facility

$4,355.00

Service Code	HCPCS C1821
Hospital Charge Code	64907467
Hospital Revenue Code	278
Min. Negotiated Rate	$2,177.50
Max. Negotiated Rate	$2,177.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,177.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,177.50

TAP SPINE

Facility

$4,355.00

Service Code	HCPCS C1821
Hospital Charge Code	64907467
Hospital Revenue Code	278
Min. Negotiated Rate	$1,524.25
Max. Negotiated Rate	$4,572.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,395.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,609.27
Rate for Payer: Aetna Government	$1,609.27
Rate for Payer: Brighton Health Commercial	$2,613.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,177.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,504.12
Rate for Payer: EmblemHealth Commercial	$2,177.50
Rate for Payer: Fidelis Medicare Advantage	$4,572.75
Rate for Payer: Group Health Inc Commercial	$2,177.50
Rate for Payer: Group Health Inc Medicare	$1,524.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,177.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,177.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,830.75

TAP STRAIGHT 4.0

Facility

$807.50

Service Code	HCPCS C1713
Hospital Charge Code	64907513
Hospital Revenue Code	278
Min. Negotiated Rate	$403.75
Max. Negotiated Rate	$403.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$403.75
Rate for Payer: Hamaspik Choice Inc Medicare	$403.75

TAP STRAIGHT 4.0

Facility

$807.50

Service Code	HCPCS C1713
Hospital Charge Code	64907513
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$847.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$444.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$484.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$403.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$464.31
Rate for Payer: EmblemHealth Commercial	$403.75
Rate for Payer: Fidelis Medicare Advantage	$847.88
Rate for Payer: Group Health Inc Commercial	$403.75
Rate for Payer: Group Health Inc Medicare	$282.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$403.75
Rate for Payer: Hamaspik Choice Inc Medicare	$403.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$524.88

TAP SURGICAL 3.5MM DIA TITANIUM

Facility

$900.08

Service Code	HCPCS C1713
Hospital Charge Code	64904441
Hospital Revenue Code	278
Min. Negotiated Rate	$450.04
Max. Negotiated Rate	$450.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.04
Rate for Payer: Hamaspik Choice Inc Medicare	$450.04

TAP SURGICAL 3.5MM DIA TITANIUM

Facility

$900.08

Service Code	HCPCS C1713
Hospital Charge Code	64904441
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$945.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$540.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.55
Rate for Payer: EmblemHealth Commercial	$450.04
Rate for Payer: Fidelis Medicare Advantage	$945.08
Rate for Payer: Group Health Inc Commercial	$450.04
Rate for Payer: Group Health Inc Medicare	$315.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.04
Rate for Payer: Hamaspik Choice Inc Medicare	$450.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.05

TAP SURGICAL 5.5MM DIA SPINAL

Facility

$1,811.15

Hospital Charge Code	64906011
Hospital Revenue Code	270
Min. Negotiated Rate	$633.90
Max. Negotiated Rate	$1,448.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$996.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$905.58
Rate for Payer: Aetna Government	$905.58
Rate for Payer: Brighton Health Commercial	$1,358.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,448.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,231.58
Rate for Payer: Group Health Inc Commercial	$905.58
Rate for Payer: Group Health Inc Medicare	$633.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$905.58
Rate for Payer: Hamaspik Choice Inc Medicare	$905.58

T & A, UNDER AGE 12

Facility

$14,691.05

Service Code	HCPCS 42820
Hospital Charge Code	40109040
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$11,018.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,772.21
Rate for Payer: Aetna Government	$6,772.21
Rate for Payer: Brighton Health Commercial	$11,018.29
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,772.21
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	$6,772.21
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,756.38
Rate for Payer: Fidelis Essential Plan QHP	$6,027.27
Rate for Payer: Fidelis Medicare Advantage	$6,772.21
Rate for Payer: Fidelis Qualified Health Plan	$6,027.27
Rate for Payer: Group Health Inc Commercial	$6,772.21
Rate for Payer: Group Health Inc Medicare	$6,772.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,345.52
Rate for Payer: Hamaspik Choice Inc Medicare	$6,772.21
Rate for Payer: Healthfirst Medicare Advantage	$5,756.38
Rate for Payer: Healthfirst QHP	$6,772.21
Rate for Payer: Senior Whole Health Medicare Advantage	$6,772.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,772.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,417.77
Rate for Payer: Wellcare Medicare	$6,433.60

T & A, UNDER AGE 12

Facility

$14,691.05

Service Code	HCPCS 42820
Hospital Charge Code	40109040
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,772.21

TAY SACHS, DNA ANALYSIS

Facility

$128.63

Service Code	HCPCS 81255
Hospital Charge Code	40603053
Hospital Revenue Code	300
Min. Negotiated Rate	$41.16
Max. Negotiated Rate	$102.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.45
Rate for Payer: Aetna Government	$51.45
Rate for Payer: Brighton Health Commercial	$96.47
Rate for Payer: Cash Price	$51.45
Rate for Payer: Cash Price	$51.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$51.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$87.47
Rate for Payer: Elderplan Medicare Advantage	$51.45
Rate for Payer: EmblemHealth Commercial	$51.45
Rate for Payer: Fidelis Essential Plan Aliesa	$43.73
Rate for Payer: Fidelis Essential Plan QHP	$45.79
Rate for Payer: Fidelis Medicare Advantage	$51.45
Rate for Payer: Fidelis Qualified Health Plan	$45.79
Rate for Payer: Group Health Inc Commercial	$51.45
Rate for Payer: Group Health Inc Medicare	$51.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.32
Rate for Payer: Hamaspik Choice Inc Medicare	$51.45
Rate for Payer: Healthfirst Medicare Advantage	$51.45
Rate for Payer: Healthfirst QHP	$51.45
Rate for Payer: Senior Whole Health Medicare Advantage	$51.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41.16
Rate for Payer: Wellcare Medicare	$46.30

TAY SACHS, DNA ANALYSIS

Facility

$128.63

Service Code	HCPCS 81255
Hospital Charge Code	40603053
Hospital Revenue Code	300
Rate for Payer: Cash Price	$51.45

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$15,004.15

Service Code	HCPCS 37248
Hospital Charge Code	66524706
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,609.72

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$15,004.15

Service Code	HCPCS 37248
Hospital Charge Code	66524706
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$11,253.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,609.72
Rate for Payer: Aetna Government	$6,609.72
Rate for Payer: Brighton Health Commercial	$11,253.11
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,609.72
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	$6,609.72
Rate for Payer: EmblemHealth Commercial	$6,609.72
Rate for Payer: Fidelis Essential Plan Aliesa	$5,618.26
Rate for Payer: Fidelis Essential Plan QHP	$5,882.65
Rate for Payer: Fidelis Medicare Advantage	$6,609.72
Rate for Payer: Fidelis Qualified Health Plan	$5,882.65
Rate for Payer: Group Health Inc Commercial	$6,609.72
Rate for Payer: Group Health Inc Medicare	$6,609.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6,609.72
Rate for Payer: Healthfirst Medicare Advantage	$5,618.26
Rate for Payer: Healthfirst QHP	$6,609.72
Rate for Payer: Senior Whole Health Medicare Advantage	$6,609.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,609.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,287.78
Rate for Payer: Wellcare Medicare	$6,279.23

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$15,004.15

Service Code	HCPCS 37248
Hospital Charge Code	40034512
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,609.72

TBA 1ST ARTERY (NOT DIALYSIS)

Facility

$15,004.15

Service Code	HCPCS 37248
Hospital Charge Code	40034512
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$11,253.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,609.72
Rate for Payer: Aetna Government	$6,609.72
Rate for Payer: Brighton Health Commercial	$11,253.11
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,609.72
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	$6,609.72
Rate for Payer: EmblemHealth Commercial	$6,609.72
Rate for Payer: Fidelis Essential Plan Aliesa	$5,618.26
Rate for Payer: Fidelis Essential Plan QHP	$5,882.65
Rate for Payer: Fidelis Medicare Advantage	$6,609.72
Rate for Payer: Fidelis Qualified Health Plan	$5,882.65
Rate for Payer: Group Health Inc Commercial	$6,609.72
Rate for Payer: Group Health Inc Medicare	$6,609.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6,609.72
Rate for Payer: Healthfirst Medicare Advantage	$5,618.26
Rate for Payer: Healthfirst QHP	$6,609.72
Rate for Payer: Senior Whole Health Medicare Advantage	$6,609.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,609.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,287.78
Rate for Payer: Wellcare Medicare	$6,279.23

TBA_1ST_ARTERY_(NOT DIALYSIS)

Facility

$15,004.15

Service Code	HCPCS 37248
Hospital Charge Code	66574713
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$11,253.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,609.72
Rate for Payer: Aetna Government	$6,609.72
Rate for Payer: Brighton Health Commercial	$11,253.11
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,609.72
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	$6,609.72
Rate for Payer: EmblemHealth Commercial	$6,609.72
Rate for Payer: Fidelis Essential Plan Aliesa	$5,618.26
Rate for Payer: Fidelis Essential Plan QHP	$5,882.65
Rate for Payer: Fidelis Medicare Advantage	$6,609.72
Rate for Payer: Fidelis Qualified Health Plan	$5,882.65
Rate for Payer: Group Health Inc Commercial	$6,609.72
Rate for Payer: Group Health Inc Medicare	$6,609.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6,609.72
Rate for Payer: Healthfirst Medicare Advantage	$5,618.26
Rate for Payer: Healthfirst QHP	$6,609.72
Rate for Payer: Senior Whole Health Medicare Advantage	$6,609.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,609.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,287.78
Rate for Payer: Wellcare Medicare	$6,279.23

TBA_1ST_ARTERY_(NOT DIALYSIS)

Facility

$15,004.15

Service Code	HCPCS 37248
Hospital Charge Code	66574713
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,609.72

TBA 1ST ARTERY (NOT LE)

Facility

$15,004.15

Service Code	HCPCS 37246
Hospital Charge Code	66524704
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$11,253.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,609.72
Rate for Payer: Aetna Government	$6,609.72
Rate for Payer: Brighton Health Commercial	$11,253.11
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,609.72
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	$6,609.72
Rate for Payer: EmblemHealth Commercial	$6,609.72
Rate for Payer: Fidelis Essential Plan Aliesa	$5,618.26
Rate for Payer: Fidelis Essential Plan QHP	$5,882.65
Rate for Payer: Fidelis Medicare Advantage	$6,609.72
Rate for Payer: Fidelis Qualified Health Plan	$5,882.65
Rate for Payer: Group Health Inc Commercial	$6,609.72
Rate for Payer: Group Health Inc Medicare	$6,609.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6,609.72
Rate for Payer: Healthfirst Medicare Advantage	$5,618.26
Rate for Payer: Healthfirst QHP	$6,609.72
Rate for Payer: Senior Whole Health Medicare Advantage	$6,609.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,609.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,287.78
Rate for Payer: Wellcare Medicare	$6,279.23

TBA 1ST ARTERY (NOT LE)

Facility

$15,004.15

Service Code	HCPCS 37246
Hospital Charge Code	66524704
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,609.72

TBA 1ST ARTERY (NOT LE)

Facility

$15,004.15

Service Code	HCPCS 37246
Hospital Charge Code	40034510
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$11,253.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,609.72
Rate for Payer: Aetna Government	$6,609.72
Rate for Payer: Brighton Health Commercial	$11,253.11
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,609.72
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	$6,609.72
Rate for Payer: EmblemHealth Commercial	$6,609.72
Rate for Payer: Fidelis Essential Plan Aliesa	$5,618.26
Rate for Payer: Fidelis Essential Plan QHP	$5,882.65
Rate for Payer: Fidelis Medicare Advantage	$6,609.72
Rate for Payer: Fidelis Qualified Health Plan	$5,882.65
Rate for Payer: Group Health Inc Commercial	$6,609.72
Rate for Payer: Group Health Inc Medicare	$6,609.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6,609.72
Rate for Payer: Healthfirst Medicare Advantage	$5,618.26
Rate for Payer: Healthfirst QHP	$6,609.72
Rate for Payer: Senior Whole Health Medicare Advantage	$6,609.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,609.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,287.78
Rate for Payer: Wellcare Medicare	$6,279.23

TBA 1ST ARTERY (NOT LE)

Facility

$15,004.15

Service Code	HCPCS 37246
Hospital Charge Code	40034510
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,609.72

TBA_1ST_ARTERY_(NOT LE)

Facility

$15,004.15

Service Code	HCPCS 37246
Hospital Charge Code	66574711
Hospital Revenue Code	361
Min. Negotiated Rate	$2,477.75
Max. Negotiated Rate	$11,253.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,609.72
Rate for Payer: Aetna Government	$6,609.72
Rate for Payer: Brighton Health Commercial	$11,253.11
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Cash Price	$6,609.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,609.72
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	$6,609.72
Rate for Payer: EmblemHealth Commercial	$6,609.72
Rate for Payer: Fidelis Essential Plan Aliesa	$5,618.26
Rate for Payer: Fidelis Essential Plan QHP	$5,882.65
Rate for Payer: Fidelis Medicare Advantage	$6,609.72
Rate for Payer: Fidelis Qualified Health Plan	$5,882.65
Rate for Payer: Group Health Inc Commercial	$6,609.72
Rate for Payer: Group Health Inc Medicare	$6,609.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.08
Rate for Payer: Hamaspik Choice Inc Medicare	$6,609.72
Rate for Payer: Healthfirst Medicare Advantage	$5,618.26
Rate for Payer: Healthfirst QHP	$6,609.72
Rate for Payer: Senior Whole Health Medicare Advantage	$6,609.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,609.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,287.78
Rate for Payer: Wellcare Medicare	$6,279.23

TBA_1ST_ARTERY_(NOT LE)

Facility

$15,004.15

Service Code	HCPCS 37246
Hospital Charge Code	66574711
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,609.72

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$345.23

Service Code	HCPCS 36907
Hospital Charge Code	40034509
Hospital Revenue Code	361
Min. Negotiated Rate	$120.83
Max. Negotiated Rate	$5,593.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.44
Rate for Payer: Aetna Government	$135.44
Rate for Payer: Brighton Health Commercial	$258.92
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	$172.62
Rate for Payer: Group Health Inc Medicare	$120.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.62
Rate for Payer: Hamaspik Choice Inc Medicare	$172.62

TBA CENTRAL DIALYSIS SEG ADDON

Facility

$345.23

Service Code	HCPCS 36907
Hospital Charge Code	66524703
Hospital Revenue Code	361
Min. Negotiated Rate	$120.83
Max. Negotiated Rate	$5,593.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.44
Rate for Payer: Aetna Government	$135.44
Rate for Payer: Brighton Health Commercial	$258.92
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	$172.62
Rate for Payer: Group Health Inc Medicare	$120.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.62
Rate for Payer: Hamaspik Choice Inc Medicare	$172.62

Know your out-of-pocket cost for care.

All Charges