St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TX/PRO/DX INJ SAM DRUG ADD-ON

Facility

$74.38

Service Code	HCPCS 96376
Hospital Charge Code	30105932
Hospital Revenue Code	260
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$59.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.94
Rate for Payer: Aetna Government	$12.94
Rate for Payer: Brighton Health Commercial	$55.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.58
Rate for Payer: Group Health Inc Commercial	$37.19
Rate for Payer: Group Health Inc Medicare	$26.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.19
Rate for Payer: Hamaspik Choice Inc Medicare	$37.19

TX/PRO/DX INJ SAME DRUG ADD-ON

Facility

$74.38

Service Code	HCPCS 96376
Hospital Charge Code	30305932
Hospital Revenue Code	260
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$59.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.94
Rate for Payer: Aetna Government	$12.94
Rate for Payer: Brighton Health Commercial	$55.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.58
Rate for Payer: Group Health Inc Commercial	$37.19
Rate for Payer: Group Health Inc Medicare	$26.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.19
Rate for Payer: Hamaspik Choice Inc Medicare	$37.19

TX/PROPH/DG ADD SEQ INN INF

Facility

$74.38

Service Code	HCPCS 96376
Hospital Charge Code	30105933
Hospital Revenue Code	260
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$59.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.94
Rate for Payer: Aetna Government	$12.94
Rate for Payer: Brighton Health Commercial	$55.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.58
Rate for Payer: Group Health Inc Commercial	$37.19
Rate for Payer: Group Health Inc Medicare	$26.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.19
Rate for Payer: Hamaspik Choice Inc Medicare	$37.19

TX/PROPH DG ADD SEQ IV INF

Facility

$74.38

Service Code	HCPCS 96367
Hospital Charge Code	30305933
Hospital Revenue Code	260
Min. Negotiated Rate	$37.19
Max. Negotiated Rate	$81.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$81.46
Rate for Payer: Aetna Government	$81.46
Rate for Payer: Brighton Health Commercial	$55.78
Rate for Payer: Cash Price	$81.46
Rate for Payer: Cash Price	$81.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$81.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.58
Rate for Payer: Elderplan Medicare Advantage	$81.46
Rate for Payer: EmblemHealth Commercial	$81.46
Rate for Payer: Fidelis Essential Plan Aliesa	$69.24
Rate for Payer: Fidelis Essential Plan QHP	$72.50
Rate for Payer: Fidelis Medicare Advantage	$81.46
Rate for Payer: Fidelis Qualified Health Plan	$72.50
Rate for Payer: Group Health Inc Commercial	$81.46
Rate for Payer: Group Health Inc Medicare	$81.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.19
Rate for Payer: Hamaspik Choice Inc Medicare	$81.46
Rate for Payer: Healthfirst Medicare Advantage	$69.24
Rate for Payer: Healthfirst QHP	$81.46
Rate for Payer: Senior Whole Health Medicare Advantage	$81.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.17
Rate for Payer: Wellcare Medicare	$77.39

TX/PROPH DG ADD SEQ IV INF

Facility

$74.38

Service Code	HCPCS 96367
Hospital Charge Code	30305933
Hospital Revenue Code	260
Rate for Payer: Cash Price	$81.46

TYCO HEALTH HAND SWITCH ELECTRODE

Facility

$454.72

Hospital Charge Code	40205552
Hospital Revenue Code	270
Min. Negotiated Rate	$159.15
Max. Negotiated Rate	$363.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$250.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$227.36
Rate for Payer: Aetna Government	$227.36
Rate for Payer: Brighton Health Commercial	$341.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$363.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$309.21
Rate for Payer: Group Health Inc Commercial	$227.36
Rate for Payer: Group Health Inc Medicare	$159.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$227.36
Rate for Payer: Hamaspik Choice Inc Medicare	$227.36

TYMPANIC MEMBRANE REPAIR

Facility

$4,086.83

Service Code	HCPCS 69610
Hospital Charge Code	40109207
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,763.60

TYMPANIC MEMBRANE REPAIR

Facility

$4,086.83

Service Code	HCPCS 69610
Hospital Charge Code	40109207
Hospital Revenue Code	360
Min. Negotiated Rate	$1,410.88
Max. Negotiated Rate	$3,065.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,763.60
Rate for Payer: Aetna Government	$1,763.60
Rate for Payer: Brighton Health Commercial	$3,065.12
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Cash Price	$1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,763.60
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	$1,763.60
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,499.06
Rate for Payer: Fidelis Essential Plan QHP	$1,569.60
Rate for Payer: Fidelis Medicare Advantage	$1,763.60
Rate for Payer: Fidelis Qualified Health Plan	$1,569.60
Rate for Payer: Group Health Inc Commercial	$1,763.60
Rate for Payer: Group Health Inc Medicare	$1,763.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,043.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1,763.60
Rate for Payer: Healthfirst Medicare Advantage	$1,499.06
Rate for Payer: Healthfirst QHP	$1,763.60
Rate for Payer: Senior Whole Health Medicare Advantage	$1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,410.88
Rate for Payer: Wellcare Medicare	$1,675.42

TYMPANOMETRY

Facility

$101.25

Service Code	HCPCS 92567
Hospital Charge Code	42004505
Hospital Revenue Code	471
Min. Negotiated Rate	$37.10
Max. Negotiated Rate	$81.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.38
Rate for Payer: Aetna Government	$46.38
Rate for Payer: Brighton Health Commercial	$75.94
Rate for Payer: Cash Price	$46.38
Rate for Payer: Cash Price	$46.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$46.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.85
Rate for Payer: Elderplan Medicare Advantage	$46.38
Rate for Payer: EmblemHealth Commercial	$46.38
Rate for Payer: Fidelis Essential Plan Aliesa	$39.42
Rate for Payer: Fidelis Essential Plan QHP	$41.28
Rate for Payer: Fidelis Medicare Advantage	$46.38
Rate for Payer: Fidelis Qualified Health Plan	$41.28
Rate for Payer: Group Health Inc Commercial	$46.38
Rate for Payer: Group Health Inc Medicare	$46.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.62
Rate for Payer: Hamaspik Choice Inc Medicare	$46.38
Rate for Payer: Healthfirst Medicare Advantage	$39.42
Rate for Payer: Healthfirst QHP	$46.38
Rate for Payer: Senior Whole Health Medicare Advantage	$46.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.10
Rate for Payer: Wellcare Medicare	$44.06

TYMPANOMETRY

Facility

$101.25

Service Code	HCPCS 92567
Hospital Charge Code	42004505
Hospital Revenue Code	471
Rate for Payer: Cash Price	$46.38

TYMPANOMETRY & REFLEX THRESHOLD

Facility

$419.03

Service Code	HCPCS 92550
Hospital Charge Code	30304750
Hospital Revenue Code	471
Rate for Payer: Cash Price	$180.64

TYMPANOMETRY & REFLEX THRESHOLD

Facility

$419.03

Service Code	HCPCS 92550
Hospital Charge Code	30304750
Hospital Revenue Code	471
Min. Negotiated Rate	$144.51
Max. Negotiated Rate	$335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Brighton Health Commercial	$314.27
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$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: Elderplan Medicare Advantage	$180.64
Rate for Payer: EmblemHealth Commercial	$180.64
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$209.52
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

Tympanostomy (requiring insertion of ventilating tube), general anesthesia

Facility

$2,915.00

Service Code	CPT 69436
Hospital Revenue Code	360
Min. Negotiated Rate	$1,410.88
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,763.60
Rate for Payer: Aetna Government	$1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,763.60
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	$1,763.60
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,499.06
Rate for Payer: Fidelis Essential Plan QHP	$1,569.60
Rate for Payer: Fidelis Medicare Advantage	$1,763.60
Rate for Payer: Fidelis Qualified Health Plan	$1,569.60
Rate for Payer: Group Health Inc Commercial	$1,763.60
Rate for Payer: Group Health Inc Medicare	$1,763.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,763.60
Rate for Payer: Healthfirst Medicare Advantage	$1,499.06
Rate for Payer: Healthfirst QHP	$1,763.60
Rate for Payer: Senior Whole Health Medicare Advantage	$1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,410.88
Rate for Payer: Wellcare Medicare	$1,675.42

TYPHOID VACCINE CAP POLYSAC 25MCG

Facility

$125.00

Service Code	HCPCS 90691
Hospital Charge Code	41655891
Hospital Revenue Code	636
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$81.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.85
Rate for Payer: Aetna Government	$77.85
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.88
Rate for Payer: Group Health Inc Commercial	$62.50
Rate for Payer: Group Health Inc Medicare	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.25

TYPHOID VACCINE CAP POLYSAC 25MCG

Facility

$125.00

Service Code	HCPCS 90691
Hospital Charge Code	41645891
Hospital Revenue Code	636
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$62.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50

TYPHOID VACCINE CAP POLYSAC 25MCG

Facility

$125.00

Service Code	HCPCS 90691
Hospital Charge Code	41645891
Hospital Revenue Code	636
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$81.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$77.85
Rate for Payer: Aetna Government	$77.85
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.88
Rate for Payer: Group Health Inc Commercial	$62.50
Rate for Payer: Group Health Inc Medicare	$43.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.25

TYPHOID VACCINE CAP POLYSAC 25MCG

Facility

$125.00

Service Code	HCPCS 90691
Hospital Charge Code	41655891
Hospital Revenue Code	636
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$62.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50

TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY [183805]

Facility

$319.06

Service Code	NDC 49281079051
Hospital Charge Code	49281079051
Hospital Revenue Code	250
Min. Negotiated Rate	$111.67
Max. Negotiated Rate	$255.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$175.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$159.53
Rate for Payer: Aetna Government	$159.53
Rate for Payer: Brighton Health Commercial	$239.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$255.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$216.96
Rate for Payer: Group Health Inc Commercial	$159.53
Rate for Payer: Group Health Inc Medicare	$111.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.53
Rate for Payer: Hamaspik Choice Inc Medicare	$159.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$207.39

TYVEK ROLL

Facility

$146.00

Hospital Charge Code	64905293
Hospital Revenue Code	270
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$116.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$73.00
Rate for Payer: Aetna Government	$73.00
Rate for Payer: Brighton Health Commercial	$109.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$99.28
Rate for Payer: Group Health Inc Commercial	$73.00
Rate for Payer: Group Health Inc Medicare	$51.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$73.00
Rate for Payer: Hamaspik Choice Inc Medicare	$73.00

TYVEK STERILIZATION ROLLS

Facility

$484.30

Hospital Charge Code	64905297
Hospital Revenue Code	270
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$387.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$266.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$242.15
Rate for Payer: Aetna Government	$242.15
Rate for Payer: Brighton Health Commercial	$363.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$387.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$329.32
Rate for Payer: Group Health Inc Commercial	$242.15
Rate for Payer: Group Health Inc Medicare	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$242.15
Rate for Payer: Hamaspik Choice Inc Medicare	$242.15

TYVEL ROLL STERILZATION ROLLS

Facility

$151.25

Hospital Charge Code	64905303
Hospital Revenue Code	270
Min. Negotiated Rate	$52.94
Max. Negotiated Rate	$121.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$83.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.62
Rate for Payer: Aetna Government	$75.62
Rate for Payer: Brighton Health Commercial	$113.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$121.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.85
Rate for Payer: Group Health Inc Commercial	$75.62
Rate for Payer: Group Health Inc Medicare	$52.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.62
Rate for Payer: Hamaspik Choice Inc Medicare	$75.62

UA DIP STICK

Facility

$8.70

Service Code	HCPCS 81002
Hospital Charge Code	30301294
Hospital Revenue Code	300
Rate for Payer: Cash Price	$3.48

UA DIP STICK

Facility

$8.70

Service Code	HCPCS 81002
Hospital Charge Code	30301294
Hospital Revenue Code	300
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$6.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$6.52
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cash Price	$3.48
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Elderplan Medicare Advantage	$3.48
Rate for Payer: EmblemHealth Commercial	$3.48
Rate for Payer: Fidelis Essential Plan Aliesa	$2.96
Rate for Payer: Fidelis Essential Plan QHP	$3.10
Rate for Payer: Fidelis Medicare Advantage	$3.48
Rate for Payer: Fidelis Qualified Health Plan	$3.10
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$3.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: Healthfirst Medicare Advantage	$3.48
Rate for Payer: Healthfirst QHP	$3.48
Rate for Payer: Senior Whole Health Medicare Advantage	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$3.13

UA MACRO

Facility

$7.93

Service Code	HCPCS 81001
Hospital Charge Code	40626015
Hospital Revenue Code	307
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$5.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.17
Rate for Payer: Aetna Government	$3.17
Rate for Payer: Brighton Health Commercial	$5.95
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cash Price	$3.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.26
Rate for Payer: Elderplan Medicare Advantage	$3.17
Rate for Payer: EmblemHealth Commercial	$3.17
Rate for Payer: Fidelis Essential Plan Aliesa	$2.69
Rate for Payer: Fidelis Essential Plan QHP	$2.82
Rate for Payer: Fidelis Medicare Advantage	$3.17
Rate for Payer: Fidelis Qualified Health Plan	$2.82
Rate for Payer: Group Health Inc Commercial	$3.17
Rate for Payer: Group Health Inc Medicare	$3.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3.17
Rate for Payer: Healthfirst Medicare Advantage	$3.17
Rate for Payer: Healthfirst QHP	$3.17
Rate for Payer: Senior Whole Health Medicare Advantage	$3.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.54
Rate for Payer: Wellcare Medicare	$2.85

UA MACRO

Facility

$7.93

Service Code	HCPCS 81001
Hospital Charge Code	40626015
Hospital Revenue Code	307
Rate for Payer: Cash Price	$3.17

Know your out-of-pocket cost for care.

All Charges