St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

THROMBECTOMY POPLITEAL ARTERY

Facility

$13,920.70

Service Code	HCPCS 34203
Hospital Charge Code	40033214
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,354.94

THROMBECTOMY POPLITEAL ARTERY

Facility

$13,920.70

Service Code	HCPCS 34203
Hospital Charge Code	40033214
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$10,440.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,354.94
Rate for Payer: Aetna Government	$6,354.94
Rate for Payer: Brighton Health Commercial	$10,440.52
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$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: Elderplan Medicare Advantage	$6,354.94
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,401.70
Rate for Payer: Fidelis Essential Plan QHP	$5,655.90
Rate for Payer: Fidelis Medicare Advantage	$6,354.94
Rate for Payer: Fidelis Qualified Health Plan	$5,655.90
Rate for Payer: Group Health Inc Commercial	$6,354.94
Rate for Payer: Group Health Inc Medicare	$6,354.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.35
Rate for Payer: Hamaspik Choice Inc Medicare	$6,354.94
Rate for Payer: Healthfirst Medicare Advantage	$5,401.70
Rate for Payer: Healthfirst QHP	$6,354.94
Rate for Payer: Senior Whole Health Medicare Advantage	$6,354.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,354.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,083.95
Rate for Payer: Wellcare Medicare	$6,037.19

THROMBECTOMY VENA CAVA, ILIAC

Facility

$4,111.23

Service Code	HCPCS 34401
Hospital Charge Code	40039867
Hospital Revenue Code	360
Min. Negotiated Rate	$1,438.93
Max. Negotiated Rate	$3,083.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,261.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,633.93
Rate for Payer: Aetna Government	$1,633.93
Rate for Payer: Brighton Health Commercial	$3,083.42
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$2,055.62
Rate for Payer: Group Health Inc Medicare	$1,438.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,055.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,055.62

THROMBIN 5000 UNITS EX SOLR [11548]

Facility

$86.56

Service Code	NDC 60793021505
Hospital Charge Code	60793021505
Hospital Revenue Code	250
Min. Negotiated Rate	$30.30
Max. Negotiated Rate	$69.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.28
Rate for Payer: Aetna Government	$43.28
Rate for Payer: Brighton Health Commercial	$64.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.86
Rate for Payer: Group Health Inc Commercial	$43.28
Rate for Payer: Group Health Inc Medicare	$30.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.28
Rate for Payer: Hamaspik Choice Inc Medicare	$43.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.26

THROMBIN CLOTTING TIME

Facility

$14.43

Service Code	HCPCS 85670
Hospital Charge Code	40628376
Hospital Revenue Code	305
Rate for Payer: Cash Price	$5.77

THROMBIN CLOTTING TIME

Facility

$14.43

Service Code	HCPCS 85670
Hospital Charge Code	40628376
Hospital Revenue Code	305
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$10.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.77
Rate for Payer: Aetna Government	$5.77
Rate for Payer: Brighton Health Commercial	$10.82
Rate for Payer: Cash Price	$5.77
Rate for Payer: Cash Price	$5.77
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.77
Rate for Payer: Elderplan Medicare Advantage	$5.77
Rate for Payer: EmblemHealth Commercial	$5.77
Rate for Payer: Fidelis Essential Plan Aliesa	$4.90
Rate for Payer: Fidelis Essential Plan QHP	$5.14
Rate for Payer: Fidelis Medicare Advantage	$5.77
Rate for Payer: Fidelis Qualified Health Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$5.77
Rate for Payer: Group Health Inc Medicare	$5.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.22
Rate for Payer: Hamaspik Choice Inc Medicare	$5.77
Rate for Payer: Healthfirst Medicare Advantage	$5.77
Rate for Payer: Healthfirst QHP	$5.77
Rate for Payer: Senior Whole Health Medicare Advantage	$5.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.62
Rate for Payer: Wellcare Medicare	$5.19

THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR [89570]

Facility

$103.20

Service Code	NDC 00338032201
Hospital Charge Code	00338032201
Hospital Revenue Code	250
Min. Negotiated Rate	$36.12
Max. Negotiated Rate	$82.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.60
Rate for Payer: Aetna Government	$51.60
Rate for Payer: Brighton Health Commercial	$77.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$70.18
Rate for Payer: Group Health Inc Commercial	$51.60
Rate for Payer: Group Health Inc Medicare	$36.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.60
Rate for Payer: Hamaspik Choice Inc Medicare	$51.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.08

THROMBIN_TIME

Facility

$14.43

Service Code	HCPCS 85670
Hospital Charge Code	40629225
Hospital Revenue Code	300
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$10.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.77
Rate for Payer: Aetna Government	$5.77
Rate for Payer: Brighton Health Commercial	$10.82
Rate for Payer: Cash Price	$5.77
Rate for Payer: Cash Price	$5.77
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.77
Rate for Payer: Elderplan Medicare Advantage	$5.77
Rate for Payer: EmblemHealth Commercial	$5.77
Rate for Payer: Fidelis Essential Plan Aliesa	$4.90
Rate for Payer: Fidelis Essential Plan QHP	$5.14
Rate for Payer: Fidelis Medicare Advantage	$5.77
Rate for Payer: Fidelis Qualified Health Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$5.77
Rate for Payer: Group Health Inc Medicare	$5.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.22
Rate for Payer: Hamaspik Choice Inc Medicare	$5.77
Rate for Payer: Healthfirst Medicare Advantage	$5.77
Rate for Payer: Healthfirst QHP	$5.77
Rate for Payer: Senior Whole Health Medicare Advantage	$5.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.62
Rate for Payer: Wellcare Medicare	$5.19

THROMBIN_TIME

Facility

$14.43

Service Code	HCPCS 85670
Hospital Charge Code	40629225
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.77

THROMBIN TOPICAL 5000 UNITS

Facility

$116.64

Hospital Charge Code	41644943
Hospital Revenue Code	250
Min. Negotiated Rate	$40.82
Max. Negotiated Rate	$93.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.32
Rate for Payer: Aetna Government	$58.32
Rate for Payer: Brighton Health Commercial	$87.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.32
Rate for Payer: Group Health Inc Commercial	$58.32
Rate for Payer: Group Health Inc Medicare	$40.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.32
Rate for Payer: Hamaspik Choice Inc Medicare	$58.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.82

THROMBIN TOPICAL 5000 UNITS

Facility

$116.64

Hospital Charge Code	41654943
Hospital Revenue Code	250
Min. Negotiated Rate	$40.82
Max. Negotiated Rate	$93.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.32
Rate for Payer: Aetna Government	$58.32
Rate for Payer: Brighton Health Commercial	$87.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.32
Rate for Payer: Group Health Inc Commercial	$58.32
Rate for Payer: Group Health Inc Medicare	$40.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.32
Rate for Payer: Hamaspik Choice Inc Medicare	$58.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.82

THROMBO ART/VEN THERAPY

Facility

$4,940.28

Service Code	HCPCS 37213
Hospital Charge Code	41102811
Hospital Revenue Code	361
Min. Negotiated Rate	$1,888.00
Max. Negotiated Rate	$3,705.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Brighton Health Commercial	$3,705.21
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$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: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$3,686.08
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,686.08
Rate for Payer: Group Health Inc Medicare	$3,686.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst Medicare Advantage	$3,133.17
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

THROMBO ART/VEN THERAPY

Facility

$4,940.28

Service Code	HCPCS 37213
Hospital Charge Code	41102811
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,686.08

THROMBOENDARTARECTOMY-BRACHIAL

Facility

$13,920.70

Service Code	HCPCS 35321
Hospital Charge Code	40039588
Hospital Revenue Code	360
Rate for Payer: Cash Price	$6,354.94

THROMBOENDARTARECTOMY-BRACHIAL

Facility

$13,920.70

Service Code	HCPCS 35321
Hospital Charge Code	40039588
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$10,440.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,354.94
Rate for Payer: Aetna Government	$6,354.94
Rate for Payer: Brighton Health Commercial	$10,440.52
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Cash Price	$6,354.94
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$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: Elderplan Medicare Advantage	$6,354.94
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$5,401.70
Rate for Payer: Fidelis Essential Plan QHP	$5,655.90
Rate for Payer: Fidelis Medicare Advantage	$6,354.94
Rate for Payer: Fidelis Qualified Health Plan	$5,655.90
Rate for Payer: Group Health Inc Commercial	$6,354.94
Rate for Payer: Group Health Inc Medicare	$6,354.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,960.35
Rate for Payer: Hamaspik Choice Inc Medicare	$6,354.94
Rate for Payer: Healthfirst Medicare Advantage	$5,401.70
Rate for Payer: Healthfirst QHP	$6,354.94
Rate for Payer: Senior Whole Health Medicare Advantage	$6,354.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,354.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,083.95
Rate for Payer: Wellcare Medicare	$6,037.19

THROMBOENDARTARECTOMY CAROTID

Facility

$6,846.53

Service Code	HCPCS 35301
Hospital Charge Code	40033203
Hospital Revenue Code	360
Min. Negotiated Rate	$1,290.82
Max. Negotiated Rate	$5,134.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,765.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,290.82
Rate for Payer: Aetna Government	$1,290.82
Rate for Payer: Brighton Health Commercial	$5,134.90
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$3,423.26
Rate for Payer: Group Health Inc Medicare	$2,396.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,423.26
Rate for Payer: Hamaspik Choice Inc Medicare	$3,423.26

THROMBOENDARTERECTOMY AORTO ILIAC

Facility

$4,705.60

Service Code	HCPCS 35361
Hospital Charge Code	40039872
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,529.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,588.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,753.55
Rate for Payer: Aetna Government	$1,753.55
Rate for Payer: Brighton Health Commercial	$3,529.20
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$2,352.80
Rate for Payer: Group Health Inc Medicare	$1,646.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,352.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2,352.80

THROMBOENDARTERECTOMY ILIAC

Facility

$3,838.38

Service Code	HCPCS 35351
Hospital Charge Code	40039871
Hospital Revenue Code	360
Min. Negotiated Rate	$1,343.43
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,111.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,460.16
Rate for Payer: Aetna Government	$1,460.16
Rate for Payer: Brighton Health Commercial	$2,878.78
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,919.19
Rate for Payer: Group Health Inc Medicare	$1,343.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,919.19
Rate for Payer: Hamaspik Choice Inc Medicare	$1,919.19

THROMBOPLASTIN TIME PARTIAL

Facility

$16.18

Service Code	HCPCS 85732
Hospital Charge Code	40629621
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$12.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.47
Rate for Payer: Aetna Government	$6.47
Rate for Payer: Brighton Health Commercial	$12.14
Rate for Payer: Cash Price	$6.47
Rate for Payer: Cash Price	$6.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.70
Rate for Payer: Elderplan Medicare Advantage	$6.47
Rate for Payer: EmblemHealth Commercial	$6.47
Rate for Payer: Fidelis Essential Plan Aliesa	$5.50
Rate for Payer: Fidelis Essential Plan QHP	$5.76
Rate for Payer: Fidelis Medicare Advantage	$6.47
Rate for Payer: Fidelis Qualified Health Plan	$5.76
Rate for Payer: Group Health Inc Commercial	$6.47
Rate for Payer: Group Health Inc Medicare	$6.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.09
Rate for Payer: Hamaspik Choice Inc Medicare	$6.47
Rate for Payer: Healthfirst Medicare Advantage	$6.47
Rate for Payer: Healthfirst QHP	$6.47
Rate for Payer: Senior Whole Health Medicare Advantage	$6.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.18
Rate for Payer: Wellcare Medicare	$5.82

THROMBOPLASTIN TIME PARTIAL

Facility

$16.18

Service Code	HCPCS 85732
Hospital Charge Code	40629621
Hospital Revenue Code	300
Rate for Payer: Cash Price	$6.47

THROMBO VENOUS THERAPY

Facility

$8,393.53

Service Code	HCPCS 37212
Hospital Charge Code	41102606
Hospital Revenue Code	361
Rate for Payer: Cash Price	$3,686.08

THROMBO VENOUS THERAPY

Facility

$8,393.53

Service Code	HCPCS 37212
Hospital Charge Code	41102606
Hospital Revenue Code	361
Min. Negotiated Rate	$1,888.00
Max. Negotiated Rate	$6,295.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,686.08
Rate for Payer: Aetna Government	$3,686.08
Rate for Payer: Brighton Health Commercial	$6,295.15
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$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: Elderplan Medicare Advantage	$3,686.08
Rate for Payer: EmblemHealth Commercial	$3,686.08
Rate for Payer: Fidelis Essential Plan Aliesa	$3,133.17
Rate for Payer: Fidelis Essential Plan QHP	$3,280.61
Rate for Payer: Fidelis Medicare Advantage	$3,686.08
Rate for Payer: Fidelis Qualified Health Plan	$3,280.61
Rate for Payer: Group Health Inc Commercial	$3,686.08
Rate for Payer: Group Health Inc Medicare	$3,686.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$3,686.08
Rate for Payer: Healthfirst Medicare Advantage	$3,133.17
Rate for Payer: Healthfirst QHP	$3,686.08
Rate for Payer: Senior Whole Health Medicare Advantage	$3,686.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,948.86
Rate for Payer: Wellcare Medicare	$3,501.78

THROMB+STENT PERIPH DIALYS SEG

Facility

$48,278.18

Service Code	HCPCS 36906
Hospital Charge Code	40034519
Hospital Revenue Code	361
Min. Negotiated Rate	$342.00
Max. Negotiated Rate	$36,208.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Brighton Health Commercial	$36,208.64
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
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	$20,278.00
Rate for Payer: EmblemHealth Commercial	$20,278.00
Rate for Payer: Fidelis Essential Plan Aliesa	$17,236.30
Rate for Payer: Fidelis Essential Plan QHP	$18,047.42
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Fidelis Qualified Health Plan	$18,047.42
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,139.09
Rate for Payer: Hamaspik Choice Inc Medicare	$20,278.00
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20,278.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40
Rate for Payer: Wellcare Medicare	$19,264.10

THROMB+STENT PERIPH DIALYS SEG

Facility

$48,278.18

Service Code	HCPCS 36906
Hospital Charge Code	40034519
Hospital Revenue Code	361
Rate for Payer: Cash Price	$20,278.00

THROMB+TBA PERIPH DIALYSIS SEG

Facility

$30,010.30

Service Code	HCPCS 36905
Hospital Charge Code	40034507
Hospital Revenue Code	361
Rate for Payer: Cash Price	$12,721.98

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