St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZZ OMNIPAQUE 300/150ML PER ML

Facility

$1.80

Service Code	HCPCS Q9967
Hospital Charge Code	41563110
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

ZZ OMNIPAQUE 350/150ML - PER ML

Facility

$1.80

Service Code	HCPCS Q9967
Hospital Charge Code	41563108
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.15
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.15
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

ZZ OMNISCAN 10ML (GAD) INJ-PERML

Facility

$42.50

Service Code	HCPCS A9579
Hospital Charge Code	41565952
Hospital Revenue Code	254
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$34.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$31.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.90
Rate for Payer: Group Health Inc Commercial	$21.25
Rate for Payer: Group Health Inc Medicare	$14.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.25
Rate for Payer: Hamaspik Choice Inc Medicare	$21.25
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.62

ZZ OMNISCAN 15ML (GAD) INJ-PER ML

Facility

$63.75

Service Code	HCPCS A9579
Hospital Charge Code	41565951
Hospital Revenue Code	254
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$51.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$47.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.35
Rate for Payer: Group Health Inc Commercial	$31.88
Rate for Payer: Group Health Inc Medicare	$22.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.88
Rate for Payer: Hamaspik Choice Inc Medicare	$31.88
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.44

ZZ OMNISCAN 20ML (GAD) INJ

Facility

$85.00

Service Code	HCPCS A9579
Hospital Charge Code	41565950
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$68.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$63.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.80
Rate for Payer: Group Health Inc Commercial	$42.50
Rate for Payer: Group Health Inc Medicare	$29.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.50
Rate for Payer: Hamaspik Choice Inc Medicare	$42.50
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$55.25

ZZ ONCONTROL BONE NEEDLE SET

Facility

$1,140.00

Hospital Charge Code	41564623
Hospital Revenue Code	272
Min. Negotiated Rate	$399.00
Max. Negotiated Rate	$912.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$627.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$570.00
Rate for Payer: Aetna Government	$570.00
Rate for Payer: Brighton Health Commercial	$855.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$912.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$775.20
Rate for Payer: Group Health Inc Commercial	$570.00
Rate for Payer: Group Health Inc Medicare	$399.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.00
Rate for Payer: Hamaspik Choice Inc Medicare	$570.00

ZZ ONCONTROL SYS PROC TRAY

Facility

$600.00

Hospital Charge Code	41564621
Hospital Revenue Code	272
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$480.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$300.00
Rate for Payer: Aetna Government	$300.00
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$408.00
Rate for Payer: Group Health Inc Commercial	$300.00
Rate for Payer: Group Health Inc Medicare	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00

ZZ ONEWAY STOPCOC FLL/MLL

Facility

$87.89

Hospital Charge Code	41567302
Hospital Revenue Code	270
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$70.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.94
Rate for Payer: Aetna Government	$43.94
Rate for Payer: Brighton Health Commercial	$65.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.77
Rate for Payer: Group Health Inc Commercial	$43.94
Rate for Payer: Group Health Inc Medicare	$30.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.94
Rate for Payer: Hamaspik Choice Inc Medicare	$43.94

ZZ ORTHOVITA 3 TIPS LUER

Facility

$600.00

Hospital Charge Code	41563102
Hospital Revenue Code	270
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$480.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$300.00
Rate for Payer: Aetna Government	$300.00
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$408.00
Rate for Payer: Group Health Inc Commercial	$300.00
Rate for Payer: Group Health Inc Medicare	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00

ZZ ORTHOVITA CARTRIDGE 5 CC

Facility

$2,000.00

Hospital Charge Code	41563103
Hospital Revenue Code	270
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,000.00
Rate for Payer: Aetna Government	$1,000.00
Rate for Payer: Brighton Health Commercial	$1,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,360.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

ZZ ORTHOVITA DELIVERY GUN

Facility

$1,100.00

Hospital Charge Code	41563101
Hospital Revenue Code	270
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$880.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.00
Rate for Payer: Aetna Government	$550.00
Rate for Payer: Brighton Health Commercial	$825.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$880.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$748.00
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

ZZ ORTHOVITA DELIVERY KIT

Facility

$1,100.00

Hospital Charge Code	41563100
Hospital Revenue Code	272
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$880.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.00
Rate for Payer: Aetna Government	$550.00
Rate for Payer: Brighton Health Commercial	$825.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$880.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$748.00
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

ZZ PALMAZ STENT-ILIAC 30

Facility

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567144
Hospital Revenue Code	278
Min. Negotiated Rate	$1,222.60
Max. Negotiated Rate	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60

ZZ PALMAZ STENT-ILIAC 30

Facility

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567144
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,567.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,344.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,467.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,222.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,405.98
Rate for Payer: EmblemHealth Commercial	$1,222.60
Rate for Payer: Fidelis Medicare Advantage	$2,567.45
Rate for Payer: Group Health Inc Commercial	$1,222.60
Rate for Payer: Group Health Inc Medicare	$855.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,589.37

ZZ PALMAZ STENT ILIAC 39

Facility

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567145
Hospital Revenue Code	278
Min. Negotiated Rate	$1,222.60
Max. Negotiated Rate	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60

ZZ PALMAZ STENT ILIAC 39

Facility

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567145
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,567.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,344.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,467.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,222.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,405.98
Rate for Payer: EmblemHealth Commercial	$1,222.60
Rate for Payer: Fidelis Medicare Advantage	$2,567.45
Rate for Payer: Group Health Inc Commercial	$1,222.60
Rate for Payer: Group Health Inc Medicare	$855.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,589.37

ZZ PALMAZ STENT-RENAL 15

Facility

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,222.60
Max. Negotiated Rate	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60

ZZ PALMAZ STENT-RENAL 15

Facility

$2,445.19

Service Code	HCPCS C1876
Hospital Charge Code	41567146
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$2,567.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,344.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$1,467.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,222.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,405.98
Rate for Payer: EmblemHealth Commercial	$1,222.60
Rate for Payer: Fidelis Medicare Advantage	$2,567.45
Rate for Payer: Group Health Inc Commercial	$1,222.60
Rate for Payer: Group Health Inc Medicare	$855.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,222.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,222.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,589.37

ZZ PARALLAX ACRYLIC RESIN

Facility

$365.72

Hospital Charge Code	41569568
Hospital Revenue Code	270
Min. Negotiated Rate	$128.00
Max. Negotiated Rate	$292.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$201.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$182.86
Rate for Payer: Aetna Government	$182.86
Rate for Payer: Brighton Health Commercial	$274.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$292.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.69
Rate for Payer: Group Health Inc Commercial	$182.86
Rate for Payer: Group Health Inc Medicare	$128.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.86
Rate for Payer: Hamaspik Choice Inc Medicare	$182.86

ZZ PARALLAX TRACER BONE

Facility

$211.21

Hospital Charge Code	41569567
Hospital Revenue Code	270
Min. Negotiated Rate	$73.92
Max. Negotiated Rate	$168.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.60
Rate for Payer: Aetna Government	$105.60
Rate for Payer: Brighton Health Commercial	$158.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$143.62
Rate for Payer: Group Health Inc Commercial	$105.60
Rate for Payer: Group Health Inc Medicare	$73.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.60
Rate for Payer: Hamaspik Choice Inc Medicare	$105.60

ZZ PEEL-AWAY/10F/12CM

Facility

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569274
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$80.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$45.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.02
Rate for Payer: EmblemHealth Commercial	$38.28
Rate for Payer: Fidelis Medicare Advantage	$80.38
Rate for Payer: Group Health Inc Commercial	$38.28
Rate for Payer: Group Health Inc Medicare	$26.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.76

ZZ PEEL-AWAY/10F/12CM

Facility

$76.55

Service Code	HCPCS C1892
Hospital Charge Code	41569274
Hospital Revenue Code	278
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$38.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.28
Rate for Payer: Hamaspik Choice Inc Medicare	$38.28

ZZ PEEL-AWAY/10F/32

Facility

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569275
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$84.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.57
Rate for Payer: Aetna Government	$0.57
Rate for Payer: Brighton Health Commercial	$48.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.46
Rate for Payer: EmblemHealth Commercial	$40.40
Rate for Payer: Fidelis Medicare Advantage	$84.84
Rate for Payer: Group Health Inc Commercial	$40.40
Rate for Payer: Group Health Inc Medicare	$28.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$52.52

ZZ PEEL-AWAY/10F/32

Facility

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569275
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

ZZ PEEL-AWAY/12F/15CM

Facility

$80.80

Service Code	HCPCS C1892
Hospital Charge Code	41569276
Hospital Revenue Code	278
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$40.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$40.40
Rate for Payer: Hamaspik Choice Inc Medicare	$40.40

Know your out-of-pocket cost for care.

All Charges