St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, EACH ADD'L 25 SQCM

Facility

$120.00

Service Code	CPT C5276
Hospital Charge Code	361C527601
Hospital Revenue Code	361
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$1,113.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.00
Rate for Payer: Aetna Government	$60.00
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, EACH ADD'L 25 SQCM

Facility

$120.00

Service Code	CPT C5276
Hospital Charge Code	361C527601
Hospital Revenue Code	361
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, INFANT/CHILD, 1ST 100 SQCM

Facility

$818.00

Service Code	CPT C5277
Hospital Charge Code	361C527701
Hospital Revenue Code	361
Min. Negotiated Rate	$409.00
Max. Negotiated Rate	$409.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$409.00

HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, INFANT/CHILD, 1ST 100 SQCM

Facility

$818.00

Service Code	CPT C5277
Hospital Charge Code	361C527701
Hospital Revenue Code	361
Min. Negotiated Rate	$328.29
Max. Negotiated Rate	$1,888.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$747.91
Rate for Payer: Aetna Government	$747.91
Rate for Payer: Affinity Essential Plan 1&2	$523.54
Rate for Payer: Affinity Essential Plan 3&4	$523.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$523.54
Rate for Payer: Brighton Health Commercial	$613.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$747.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$654.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$556.24
Rate for Payer: Elderplan Medicare Advantage	$747.91
Rate for Payer: EmblemHealth Commercial	$747.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$673.12
Rate for Payer: Fidelis Essential Plan Aliesa	$635.72
Rate for Payer: Fidelis Essential Plan QHP	$665.64
Rate for Payer: Fidelis Medicare Advantage	$747.91
Rate for Payer: Fidelis Qualified Health Plan	$665.64
Rate for Payer: Group Health Inc Commercial	$747.91
Rate for Payer: Group Health Inc Medicare	$747.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$747.91
Rate for Payer: Hamaspik Choice Inc Medicare	$328.29
Rate for Payer: Healthfirst Medicare Advantage	$635.72
Rate for Payer: Healthfirst QHP	$747.91
Rate for Payer: Humana Medicare	$762.87
Rate for Payer: Senior Whole Health Medicare Advantage	$747.91
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$747.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$710.51
Rate for Payer: Wellcare Medicare	$710.51

HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, INFANT/CHILD, EACH ADD'L 100 SQCM

Facility

$261.00

Service Code	CPT C5278
Hospital Charge Code	361C527801
Hospital Revenue Code	361
Min. Negotiated Rate	$130.50
Max. Negotiated Rate	$130.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.50

HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, INFANT/CHILD, EACH ADD'L 100 SQCM

Facility

$261.00

Service Code	CPT C5278
Hospital Charge Code	361C527801
Hospital Revenue Code	361
Min. Negotiated Rate	$91.35
Max. Negotiated Rate	$1,113.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.50
Rate for Payer: Aetna Government	$130.50
Rate for Payer: Brighton Health Commercial	$195.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$177.48
Rate for Payer: EmblemHealth Commercial	$130.50
Rate for Payer: Group Health Inc Commercial	$130.50
Rate for Payer: Group Health Inc Medicare	$91.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.50
Rate for Payer: Hamaspik Choice Inc Medicare	$130.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, 1ST 25 SQCM

Facility

$1,390.00

Service Code	CPT C5271
Hospital Charge Code	361C527101
Hospital Revenue Code	361
Min. Negotiated Rate	$695.00
Max. Negotiated Rate	$695.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$695.00

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, 1ST 25 SQCM

Facility

$1,390.00

Service Code	CPT C5271
Hospital Charge Code	361C527101
Hospital Revenue Code	361
Min. Negotiated Rate	$328.29
Max. Negotiated Rate	$1,113.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$747.91
Rate for Payer: Aetna Government	$747.91
Rate for Payer: Affinity Essential Plan 1&2	$523.54
Rate for Payer: Affinity Essential Plan 3&4	$523.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$523.54
Rate for Payer: Brighton Health Commercial	$1,042.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$747.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,112.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$945.20
Rate for Payer: Elderplan Medicare Advantage	$747.91
Rate for Payer: EmblemHealth Commercial	$747.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$673.12
Rate for Payer: Fidelis Essential Plan Aliesa	$635.72
Rate for Payer: Fidelis Essential Plan QHP	$665.64
Rate for Payer: Fidelis Medicare Advantage	$747.91
Rate for Payer: Fidelis Qualified Health Plan	$665.64
Rate for Payer: Group Health Inc Commercial	$747.91
Rate for Payer: Group Health Inc Medicare	$747.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$747.91
Rate for Payer: Hamaspik Choice Inc Medicare	$328.29
Rate for Payer: Healthfirst Medicare Advantage	$635.72
Rate for Payer: Healthfirst QHP	$747.91
Rate for Payer: Humana Medicare	$762.87
Rate for Payer: Senior Whole Health Medicare Advantage	$747.91
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$747.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$747.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$710.51
Rate for Payer: Wellcare Medicare	$710.51

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, EACH ADD'L 25 SQCM

Facility

$120.00

Service Code	CPT C5272
Hospital Charge Code	361C527201
Hospital Revenue Code	361
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$1,113.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.00
Rate for Payer: Aetna Government	$36.00
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: United Healthcare Commercial	$1,113.00

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, EACH ADD'L 25 SQCM

Facility

$120.00

Service Code	CPT C5272
Hospital Charge Code	361C527201
Hospital Revenue Code	361
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, INFANT/CHILD, 1ST 100 SQCM

Facility

$2,742.00

Service Code	CPT C5273
Hospital Charge Code	361C527301
Hospital Revenue Code	361
Min. Negotiated Rate	$1,371.00
Max. Negotiated Rate	$1,371.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,371.00

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, INFANT/CHILD, 1ST 100 SQCM

Facility

$2,742.00

Service Code	CPT C5273
Hospital Charge Code	361C527301
Hospital Revenue Code	361
Min. Negotiated Rate	$981.09
Max. Negotiated Rate	$2,279.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,234.99
Rate for Payer: Aetna Government	$2,234.99
Rate for Payer: Affinity Essential Plan 1&2	$1,564.49
Rate for Payer: Affinity Essential Plan 3&4	$1,564.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,564.49
Rate for Payer: Brighton Health Commercial	$2,056.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,234.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,193.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,864.56
Rate for Payer: Elderplan Medicare Advantage	$2,234.99
Rate for Payer: EmblemHealth Commercial	$2,234.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,011.49
Rate for Payer: Fidelis Essential Plan Aliesa	$1,899.74
Rate for Payer: Fidelis Essential Plan QHP	$1,989.14
Rate for Payer: Fidelis Medicare Advantage	$2,234.99
Rate for Payer: Fidelis Qualified Health Plan	$1,989.14
Rate for Payer: Group Health Inc Commercial	$2,234.99
Rate for Payer: Group Health Inc Medicare	$2,234.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,234.99
Rate for Payer: Hamaspik Choice Inc Medicare	$981.09
Rate for Payer: Healthfirst Medicare Advantage	$1,899.74
Rate for Payer: Healthfirst QHP	$2,234.99
Rate for Payer: Humana Medicare	$2,279.69
Rate for Payer: Senior Whole Health Medicare Advantage	$2,234.99
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,234.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,234.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,123.24
Rate for Payer: Wellcare Medicare	$2,123.24

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, INFANT CHILD, EACH ADD'L 100 SQCM

Facility

$261.00

Service Code	CPT C5274
Hospital Charge Code	361C527401
Hospital Revenue Code	361
Min. Negotiated Rate	$91.35
Max. Negotiated Rate	$1,113.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.50
Rate for Payer: Aetna Government	$130.50
Rate for Payer: Brighton Health Commercial	$195.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$177.48
Rate for Payer: EmblemHealth Commercial	$130.50
Rate for Payer: Group Health Inc Commercial	$130.50
Rate for Payer: Group Health Inc Medicare	$91.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.50
Rate for Payer: Hamaspik Choice Inc Medicare	$130.50
Rate for Payer: United Healthcare Commercial	$1,113.00

HC APP LOW COST SKIN GFT, TRK/ARM/LEG, INFANT CHILD, EACH ADD'L 100 SQCM

Facility

$261.00

Service Code	CPT C5274
Hospital Charge Code	361C527401
Hospital Revenue Code	361
Min. Negotiated Rate	$130.50
Max. Negotiated Rate	$130.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.50

HC APPLY BODY CAST,RISSER JACKET

Facility

$719.00

Service Code	CPT 29010
Hospital Charge Code	5102901001
Hospital Revenue Code	510
Min. Negotiated Rate	$142.53
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$324.49
Rate for Payer: Aetna Government	$324.49
Rate for Payer: Affinity Essential Plan 1&2	$227.14
Rate for Payer: Affinity Essential Plan 3&4	$227.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$227.14
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$324.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$324.49
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$292.04
Rate for Payer: Fidelis Essential Plan Aliesa	$275.82
Rate for Payer: Fidelis Essential Plan QHP	$288.80
Rate for Payer: Fidelis Medicare Advantage	$324.49
Rate for Payer: Fidelis Qualified Health Plan	$288.80
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$324.49
Rate for Payer: Hamaspik Choice Inc Medicare	$142.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.87
Rate for Payer: Healthfirst Medicare Advantage	$275.82
Rate for Payer: Healthfirst QHP	$324.49
Rate for Payer: Humana Medicare	$330.98
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$340.71
Rate for Payer: Senior Whole Health Medicare Advantage	$324.49
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$324.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$324.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.27
Rate for Payer: Wellcare Medicare	$308.27

HC APPLY BODY CAST,RISSER JACKET

Facility

$719.00

Service Code	CPT 29010
Hospital Charge Code	5102901001
Hospital Revenue Code	510
Min. Negotiated Rate	$359.50
Max. Negotiated Rate	$359.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.50

HC APPLY BODY CAST,SHLDR-HIP+1 THIGH

Facility

$719.00

Service Code	CPT 29044
Hospital Charge Code	5102904401
Hospital Revenue Code	510
Min. Negotiated Rate	$84.71
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.79
Rate for Payer: Aetna Government	$192.79
Rate for Payer: Affinity Essential Plan 1&2	$134.95
Rate for Payer: Affinity Essential Plan 3&4	$134.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$134.95
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$192.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$192.79
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$173.51
Rate for Payer: Fidelis Essential Plan Aliesa	$163.87
Rate for Payer: Fidelis Essential Plan QHP	$171.58
Rate for Payer: Fidelis Medicare Advantage	$192.79
Rate for Payer: Fidelis Qualified Health Plan	$171.58
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.79
Rate for Payer: Hamaspik Choice Inc Medicare	$84.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$200.37
Rate for Payer: Healthfirst Medicare Advantage	$163.87
Rate for Payer: Healthfirst QHP	$192.79
Rate for Payer: Humana Medicare	$196.65
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$202.43
Rate for Payer: Senior Whole Health Medicare Advantage	$192.79
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$192.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$183.15
Rate for Payer: Wellcare Medicare	$183.15

HC APPLY BODY CAST,SHLDR-HIP+1 THIGH

Facility

$719.00

Service Code	CPT 29044
Hospital Charge Code	5102904401
Hospital Revenue Code	510
Min. Negotiated Rate	$359.50
Max. Negotiated Rate	$359.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$359.50

HC APPLY FINGER CAST

Facility

$405.00

Service Code	CPT 29086
Hospital Charge Code	5102908601
Hospital Revenue Code	510
Min. Negotiated Rate	$56.28
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$192.79
Rate for Payer: Aetna Government	$192.79
Rate for Payer: Affinity Essential Plan 1&2	$134.95
Rate for Payer: Affinity Essential Plan 3&4	$134.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$134.95
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$192.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$192.79
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$173.51
Rate for Payer: Fidelis Essential Plan Aliesa	$163.87
Rate for Payer: Fidelis Essential Plan QHP	$171.58
Rate for Payer: Fidelis Medicare Advantage	$192.79
Rate for Payer: Fidelis Qualified Health Plan	$171.58
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.79
Rate for Payer: Hamaspik Choice Inc Medicare	$56.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$56.67
Rate for Payer: Healthfirst Medicare Advantage	$163.87
Rate for Payer: Healthfirst QHP	$192.79
Rate for Payer: Humana Medicare	$196.65
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$202.43
Rate for Payer: Senior Whole Health Medicare Advantage	$192.79
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$192.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$192.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$183.15
Rate for Payer: Wellcare Medicare	$183.15

HC APPLY FINGER CAST

Facility

$405.00

Service Code	CPT 29086
Hospital Charge Code	5102908601
Hospital Revenue Code	510
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.50

HC APPLY FINGER SPLINT,STATIC

Facility

$166.00

Service Code	CPT 29130
Hospital Charge Code	5102913001
Hospital Revenue Code	510
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$83.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.00

HC APPLY FINGER SPLINT,STATIC

Facility

$166.00

Service Code	CPT 29130
Hospital Charge Code	5102913001
Hospital Revenue Code	510
Min. Negotiated Rate	$33.43
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$157.49
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$157.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33.43
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$165.36
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

HC APPLY FOREARM CAST

Facility

$674.00

Service Code	CPT 29075
Hospital Charge Code	5102907501
Hospital Revenue Code	510
Min. Negotiated Rate	$337.00
Max. Negotiated Rate	$337.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$337.00

HC APPLY FOREARM CAST

Facility

$674.00

Service Code	CPT 29075
Hospital Charge Code	5102907501
Hospital Revenue Code	510
Min. Negotiated Rate	$58.87
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$324.49
Rate for Payer: Aetna Government	$324.49
Rate for Payer: Affinity Essential Plan 1&2	$227.14
Rate for Payer: Affinity Essential Plan 3&4	$227.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$227.14
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$324.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$324.49
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$292.04
Rate for Payer: Fidelis Essential Plan Aliesa	$275.82
Rate for Payer: Fidelis Essential Plan QHP	$288.80
Rate for Payer: Fidelis Medicare Advantage	$324.49
Rate for Payer: Fidelis Qualified Health Plan	$288.80
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$324.49
Rate for Payer: Hamaspik Choice Inc Medicare	$58.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$75.23
Rate for Payer: Healthfirst Medicare Advantage	$275.82
Rate for Payer: Healthfirst QHP	$324.49
Rate for Payer: Humana Medicare	$330.98
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$340.71
Rate for Payer: Senior Whole Health Medicare Advantage	$324.49
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$324.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$324.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$308.27
Rate for Payer: Wellcare Medicare	$308.27

HC APPLY FOREARM SPLINT,DYNAMIC

Facility

$330.00

Service Code	CPT 29126
Hospital Charge Code	5102912601
Hospital Revenue Code	510
Min. Negotiated Rate	$57.94
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.49
Rate for Payer: Aetna Government	$157.49
Rate for Payer: Affinity Essential Plan 1&2	$110.24
Rate for Payer: Affinity Essential Plan 3&4	$110.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$110.24
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$157.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$157.49
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.74
Rate for Payer: Fidelis Essential Plan Aliesa	$133.87
Rate for Payer: Fidelis Essential Plan QHP	$140.17
Rate for Payer: Fidelis Medicare Advantage	$157.49
Rate for Payer: Fidelis Qualified Health Plan	$140.17
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.49
Rate for Payer: Hamaspik Choice Inc Medicare	$157.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$57.94
Rate for Payer: Healthfirst Medicare Advantage	$133.87
Rate for Payer: Healthfirst QHP	$157.49
Rate for Payer: Humana Medicare	$160.64
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$165.36
Rate for Payer: Senior Whole Health Medicare Advantage	$157.49
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$157.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$157.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.62
Rate for Payer: Wellcare Medicare	$149.62

Know your out-of-pocket cost for care.

All Charges