St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRYPTASE_

Facility

$43.18

Service Code	HCPCS 83520
Hospital Charge Code	40609092
Hospital Revenue Code	300
Rate for Payer: Cash Price	$17.27

TRYPTASE_

Facility

$43.18

Service Code	HCPCS 83520
Hospital Charge Code	40609092
Hospital Revenue Code	300
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$32.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.27
Rate for Payer: Aetna Government	$17.27
Rate for Payer: Brighton Health Commercial	$32.38
Rate for Payer: Cash Price	$17.27
Rate for Payer: Cash Price	$17.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.41
Rate for Payer: Elderplan Medicare Advantage	$17.27
Rate for Payer: EmblemHealth Commercial	$17.27
Rate for Payer: Fidelis Essential Plan Aliesa	$14.68
Rate for Payer: Fidelis Essential Plan QHP	$15.37
Rate for Payer: Fidelis Medicare Advantage	$17.27
Rate for Payer: Fidelis Qualified Health Plan	$15.37
Rate for Payer: Group Health Inc Commercial	$17.27
Rate for Payer: Group Health Inc Medicare	$17.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.59
Rate for Payer: Hamaspik Choice Inc Medicare	$17.27
Rate for Payer: Healthfirst Medicare Advantage	$17.27
Rate for Payer: Healthfirst QHP	$17.27
Rate for Payer: Senior Whole Health Medicare Advantage	$17.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.82
Rate for Payer: Wellcare Medicare	$15.54

TSFB-35-260 BENSTON WIRE .035

Facility

$46.97

Hospital Charge Code	64905028
Hospital Revenue Code	270
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$37.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.48
Rate for Payer: Aetna Government	$23.48
Rate for Payer: Brighton Health Commercial	$35.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.94
Rate for Payer: Group Health Inc Commercial	$23.48
Rate for Payer: Group Health Inc Medicare	$16.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.48
Rate for Payer: Hamaspik Choice Inc Medicare	$23.48

TSH

Facility

$42.00

Service Code	HCPCS 84443
Hospital Charge Code	40609123
Hospital Revenue Code	300
Rate for Payer: Cash Price	$16.80

TSH

Facility

$42.00

Service Code	HCPCS 84443
Hospital Charge Code	40609123
Hospital Revenue Code	300
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.80
Rate for Payer: Aetna Government	$16.80
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.59
Rate for Payer: Elderplan Medicare Advantage	$16.80
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Fidelis Essential Plan Aliesa	$14.28
Rate for Payer: Fidelis Essential Plan QHP	$14.95
Rate for Payer: Fidelis Medicare Advantage	$16.80
Rate for Payer: Fidelis Qualified Health Plan	$14.95
Rate for Payer: Group Health Inc Commercial	$16.80
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.80
Rate for Payer: Healthfirst Medicare Advantage	$16.80
Rate for Payer: Healthfirst QHP	$16.80
Rate for Payer: Senior Whole Health Medicare Advantage	$16.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.44
Rate for Payer: Wellcare Medicare	$15.12

TSH RECEPTOR ANTIBODY

Facility

$35.30

Service Code	HCPCS 82397
Hospital Charge Code	30303377
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.12

TSH RECEPTOR ANTIBODY

Facility

$35.30

Service Code	HCPCS 82397
Hospital Charge Code	30303377
Hospital Revenue Code	301
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$26.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.12
Rate for Payer: Aetna Government	$14.12
Rate for Payer: Brighton Health Commercial	$26.48
Rate for Payer: Cash Price	$14.12
Rate for Payer: Cash Price	$14.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.00
Rate for Payer: Elderplan Medicare Advantage	$14.12
Rate for Payer: EmblemHealth Commercial	$14.12
Rate for Payer: Fidelis Essential Plan Aliesa	$12.00
Rate for Payer: Fidelis Essential Plan QHP	$12.57
Rate for Payer: Fidelis Medicare Advantage	$14.12
Rate for Payer: Fidelis Qualified Health Plan	$12.57
Rate for Payer: Group Health Inc Commercial	$14.12
Rate for Payer: Group Health Inc Medicare	$14.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.65
Rate for Payer: Hamaspik Choice Inc Medicare	$14.12
Rate for Payer: Healthfirst Medicare Advantage	$14.12
Rate for Payer: Healthfirst QHP	$14.12
Rate for Payer: Senior Whole Health Medicare Advantage	$14.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.30
Rate for Payer: Wellcare Medicare	$12.71

TSH (THRID STIM HRM)QUAN SERUM

Facility

$42.00

Service Code	HCPCS 84443
Hospital Charge Code	40602350
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$31.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.80
Rate for Payer: Aetna Government	$16.80
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.59
Rate for Payer: Elderplan Medicare Advantage	$16.80
Rate for Payer: EmblemHealth Commercial	$16.80
Rate for Payer: Fidelis Essential Plan Aliesa	$14.28
Rate for Payer: Fidelis Essential Plan QHP	$14.95
Rate for Payer: Fidelis Medicare Advantage	$16.80
Rate for Payer: Fidelis Qualified Health Plan	$14.95
Rate for Payer: Group Health Inc Commercial	$16.80
Rate for Payer: Group Health Inc Medicare	$16.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.80
Rate for Payer: Healthfirst Medicare Advantage	$16.80
Rate for Payer: Healthfirst QHP	$16.80
Rate for Payer: Senior Whole Health Medicare Advantage	$16.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.44
Rate for Payer: Wellcare Medicare	$15.12

TSH (THRID STIM HRM)QUAN SERUM

Facility

$42.00

Service Code	HCPCS 84443
Hospital Charge Code	40602350
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.80

T-SPLITTER

Facility

$2,038.75

Hospital Charge Code	64907307
Hospital Revenue Code	270
Min. Negotiated Rate	$713.56
Max. Negotiated Rate	$1,631.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,121.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,019.38
Rate for Payer: Aetna Government	$1,019.38
Rate for Payer: Brighton Health Commercial	$1,529.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,631.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,386.35
Rate for Payer: Group Health Inc Commercial	$1,019.38
Rate for Payer: Group Health Inc Medicare	$713.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,019.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,019.38

T-TRANSGLUTAMINASE (TTG) IGA

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40609087
Hospital Revenue Code	300
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$21.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Brighton Health Commercial	$21.62
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cash Price	$11.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.52
Rate for Payer: Elderplan Medicare Advantage	$11.53
Rate for Payer: EmblemHealth Commercial	$11.53
Rate for Payer: Fidelis Essential Plan Aliesa	$9.80
Rate for Payer: Fidelis Essential Plan QHP	$10.26
Rate for Payer: Fidelis Medicare Advantage	$11.53
Rate for Payer: Fidelis Qualified Health Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$11.53
Rate for Payer: Group Health Inc Medicare	$11.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.42
Rate for Payer: Hamaspik Choice Inc Medicare	$11.53
Rate for Payer: Healthfirst Medicare Advantage	$11.53
Rate for Payer: Healthfirst QHP	$11.53
Rate for Payer: Senior Whole Health Medicare Advantage	$11.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.22
Rate for Payer: Wellcare Medicare	$10.38

T-TRANSGLUTAMINASE (TTG) IGA

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40609087
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.53

T-TRANSGLUTAMINASE (TTG) IGG

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40609088
Hospital Revenue Code	300
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$21.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Brighton Health Commercial	$21.62
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cash Price	$11.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.52
Rate for Payer: Elderplan Medicare Advantage	$11.53
Rate for Payer: EmblemHealth Commercial	$11.53
Rate for Payer: Fidelis Essential Plan Aliesa	$9.80
Rate for Payer: Fidelis Essential Plan QHP	$10.26
Rate for Payer: Fidelis Medicare Advantage	$11.53
Rate for Payer: Fidelis Qualified Health Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$11.53
Rate for Payer: Group Health Inc Medicare	$11.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.42
Rate for Payer: Hamaspik Choice Inc Medicare	$11.53
Rate for Payer: Healthfirst Medicare Advantage	$11.53
Rate for Payer: Healthfirst QHP	$11.53
Rate for Payer: Senior Whole Health Medicare Advantage	$11.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.22
Rate for Payer: Wellcare Medicare	$10.38

T-TRANSGLUTAMINASE (TTG) IGG

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40609088
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.53

TUBE BLAKEMORE ESOPH/GASTR

Facility

$758.30

Hospital Charge Code	64901668
Hospital Revenue Code	270
Min. Negotiated Rate	$265.40
Max. Negotiated Rate	$606.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$417.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$379.15
Rate for Payer: Aetna Government	$379.15
Rate for Payer: Brighton Health Commercial	$568.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$606.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$515.64
Rate for Payer: Group Health Inc Commercial	$379.15
Rate for Payer: Group Health Inc Medicare	$265.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$379.15
Rate for Payer: Hamaspik Choice Inc Medicare	$379.15

TUBE BLOOD DWNG GREY,LGHT Y , GRN

Facility

$1.44

Hospital Charge Code	40205035
Hospital Revenue Code	270
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72

TUBE COMP DIST

Facility

$1,152.13

Hospital Charge Code	64904541
Hospital Revenue Code	270
Min. Negotiated Rate	$403.25
Max. Negotiated Rate	$921.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$633.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$576.06
Rate for Payer: Aetna Government	$576.06
Rate for Payer: Brighton Health Commercial	$864.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$921.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$783.45
Rate for Payer: Group Health Inc Commercial	$576.06
Rate for Payer: Group Health Inc Medicare	$403.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$576.06
Rate for Payer: Hamaspik Choice Inc Medicare	$576.06

TUBE DYNAMIC TRIAX 20MM BLUE

Facility

$4,494.75

Hospital Charge Code	64904494
Hospital Revenue Code	270
Min. Negotiated Rate	$1,573.16
Max. Negotiated Rate	$3,595.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,472.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,247.38
Rate for Payer: Aetna Government	$2,247.38
Rate for Payer: Brighton Health Commercial	$3,371.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,595.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,056.43
Rate for Payer: Group Health Inc Commercial	$2,247.38
Rate for Payer: Group Health Inc Medicare	$1,573.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,247.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,247.38

TUBE DYNAMIC TRIAX 20MM BLUE

Facility

$3,066.00

Hospital Charge Code	40202157
Hospital Revenue Code	270
Min. Negotiated Rate	$1,073.10
Max. Negotiated Rate	$2,452.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,686.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,533.00
Rate for Payer: Aetna Government	$1,533.00
Rate for Payer: Brighton Health Commercial	$2,299.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,452.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,084.88
Rate for Payer: Group Health Inc Commercial	$1,533.00
Rate for Payer: Group Health Inc Medicare	$1,073.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,533.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,533.00

TUBE GASTRO 20FR 3-PORT -DYND

Facility

$63.74

Hospital Charge Code	64906568
Hospital Revenue Code	270
Min. Negotiated Rate	$22.31
Max. Negotiated Rate	$50.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.87
Rate for Payer: Aetna Government	$31.87
Rate for Payer: Brighton Health Commercial	$47.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.34
Rate for Payer: Group Health Inc Commercial	$31.87
Rate for Payer: Group Health Inc Medicare	$22.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.87
Rate for Payer: Hamaspik Choice Inc Medicare	$31.87

TUBE GASTROSTOMY 16FR

Facility

$99.90

Hospital Charge Code	64904290
Hospital Revenue Code	270
Min. Negotiated Rate	$34.96
Max. Negotiated Rate	$79.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.95
Rate for Payer: Aetna Government	$49.95
Rate for Payer: Brighton Health Commercial	$74.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.93
Rate for Payer: Group Health Inc Commercial	$49.95
Rate for Payer: Group Health Inc Medicare	$34.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.95
Rate for Payer: Hamaspik Choice Inc Medicare	$49.95

TUBE GASTROSTOMY 18FR/18

Facility

$637.50

Hospital Charge Code	64904146
Hospital Revenue Code	270
Min. Negotiated Rate	$223.12
Max. Negotiated Rate	$510.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$350.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$318.75
Rate for Payer: Aetna Government	$318.75
Rate for Payer: Brighton Health Commercial	$478.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$510.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$433.50
Rate for Payer: Group Health Inc Commercial	$318.75
Rate for Payer: Group Health Inc Medicare	$223.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.75
Rate for Payer: Hamaspik Choice Inc Medicare	$318.75

TUBE GASTROSTOMY 22FR

Facility

$99.90

Hospital Charge Code	64903079
Hospital Revenue Code	270
Min. Negotiated Rate	$34.96
Max. Negotiated Rate	$79.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$49.95
Rate for Payer: Aetna Government	$49.95
Rate for Payer: Brighton Health Commercial	$74.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.93
Rate for Payer: Group Health Inc Commercial	$49.95
Rate for Payer: Group Health Inc Medicare	$34.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.95
Rate for Payer: Hamaspik Choice Inc Medicare	$49.95

TUBE GASTROTOMY

Facility

$65.95

Hospital Charge Code	40205985
Hospital Revenue Code	270
Min. Negotiated Rate	$23.08
Max. Negotiated Rate	$52.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.98
Rate for Payer: Aetna Government	$32.98
Rate for Payer: Brighton Health Commercial	$49.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.85
Rate for Payer: Group Health Inc Commercial	$32.98
Rate for Payer: Group Health Inc Medicare	$23.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.98
Rate for Payer: Hamaspik Choice Inc Medicare	$32.98

TUBE JEJUNOSTOMY 12FR THRU PEG

Facility

$231.60

Hospital Charge Code	64904354
Hospital Revenue Code	270
Min. Negotiated Rate	$81.06
Max. Negotiated Rate	$185.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$115.80
Rate for Payer: Aetna Government	$115.80
Rate for Payer: Brighton Health Commercial	$173.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.49
Rate for Payer: Group Health Inc Commercial	$115.80
Rate for Payer: Group Health Inc Medicare	$81.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$115.80
Rate for Payer: Hamaspik Choice Inc Medicare	$115.80

Know your out-of-pocket cost for care.

All Charges