St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC MEDTRONIC STEERABLE .014

Facility

$710.00

Service Code	HCPCS C1769
Hospital Charge Code	66522013
Hospital Revenue Code	278
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$745.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$390.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$426.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$355.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$408.25
Rate for Payer: EmblemHealth Commercial	$355.00
Rate for Payer: Fidelis Medicare Advantage	$745.50
Rate for Payer: Group Health Inc Commercial	$355.00
Rate for Payer: Group Health Inc Medicare	$248.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$355.00
Rate for Payer: Hamaspik Choice Inc Medicare	$355.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.50

CC MEDTRONIC V LEAD 6947-65CM

Facility

$1,200.00

Service Code	HCPCS C1725
Hospital Charge Code	66528991
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

CC MEDTRONIC V LEAD 6947-65CM

Facility

$1,200.00

Service Code	HCPCS C1725
Hospital Charge Code	66528991
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

CC MEDTRON PROFLO 6FR NTR 100CM

Facility

$43.50

Hospital Charge Code	66528424
Hospital Revenue Code	480
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.75
Rate for Payer: Aetna Government	$21.75
Rate for Payer: Brighton Health Commercial	$32.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.58
Rate for Payer: Group Health Inc Commercial	$21.75
Rate for Payer: Group Health Inc Medicare	$15.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.75
Rate for Payer: Hamaspik Choice Inc Medicare	$21.75
Rate for Payer: United Healthcare Commercial	$316.00

CC MEDTRON PROFLO XT 6FR NTR 100C

Facility

$43.50

Hospital Charge Code	66528425
Hospital Revenue Code	480
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.75
Rate for Payer: Aetna Government	$21.75
Rate for Payer: Brighton Health Commercial	$32.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.58
Rate for Payer: Group Health Inc Commercial	$21.75
Rate for Payer: Group Health Inc Medicare	$15.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.75
Rate for Payer: Hamaspik Choice Inc Medicare	$21.75
Rate for Payer: United Healthcare Commercial	$316.00

CC MEDTRON SITESEER 5FR NTR 100CM

Facility

$43.50

Hospital Charge Code	66528426
Hospital Revenue Code	480
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.75
Rate for Payer: Aetna Government	$21.75
Rate for Payer: Brighton Health Commercial	$32.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.58
Rate for Payer: Group Health Inc Commercial	$21.75
Rate for Payer: Group Health Inc Medicare	$15.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.75
Rate for Payer: Hamaspik Choice Inc Medicare	$21.75
Rate for Payer: United Healthcare Commercial	$316.00

CC MERIT ANGIOPLASTY PACK

Facility

$34.00

Hospital Charge Code	66520309
Hospital Revenue Code	270
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$27.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.00
Rate for Payer: Aetna Government	$17.00
Rate for Payer: Brighton Health Commercial	$25.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.12
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00

CC MERIT THREE WAY- STOPCOCK

Facility

$3.30

Hospital Charge Code	66520310
Hospital Revenue Code	270
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$2.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.65
Rate for Payer: Aetna Government	$1.65
Rate for Payer: Brighton Health Commercial	$2.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.24
Rate for Payer: Group Health Inc Commercial	$1.65
Rate for Payer: Group Health Inc Medicare	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.65
Rate for Payer: Hamaspik Choice Inc Medicare	$1.65

CC MICROVOLT T-WAVE ASSESS

Facility

$419.03

Service Code	HCPCS 93025 26
Hospital Charge Code	66528666
Hospital Revenue Code	480
Rate for Payer: Cash Price	$180.64

CC MICROVOLT T-WAVE ASSESS

Facility

$419.03

Service Code	HCPCS 93025 26
Hospital Charge Code	66528666
Hospital Revenue Code	480
Min. Negotiated Rate	$126.45
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: Affinity Essential Plan 1&2	$126.45
Rate for Payer: Affinity Essential Plan 3&4	$126.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$126.45
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: 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: Humana Medicare	$184.25
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare 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

CC MP A-1 (100CM) 5F

Facility

$50.00

Hospital Charge Code	66528792
Hospital Revenue Code	480
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.00
Rate for Payer: Group Health Inc Commercial	$25.00
Rate for Payer: Group Health Inc Medicare	$17.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$316.00

CC MULTI PT DISPOSABLE SET

Facility

$74.80

Hospital Charge Code	66520251
Hospital Revenue Code	270
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$59.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.40
Rate for Payer: Aetna Government	$37.40
Rate for Payer: Brighton Health Commercial	$56.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.86
Rate for Payer: Group Health Inc Commercial	$37.40
Rate for Payer: Group Health Inc Medicare	$26.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.40
Rate for Payer: Hamaspik Choice Inc Medicare	$37.40

CC NONSELECT CATH RT HEART/MAIN P

Facility

$2,450.50

Service Code	HCPCS 36013
Hospital Charge Code	66528656
Hospital Revenue Code	360
Min. Negotiated Rate	$135.79
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$135.79
Rate for Payer: Aetna Government	$135.79
Rate for Payer: Brighton Health Commercial	$1,837.88
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	$1,225.25
Rate for Payer: Group Health Inc Medicare	$857.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,225.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,225.25
Rate for Payer: United Healthcare Commercial	$1,113.00

CC NS CATH - EXTREMITY ARTERY

Facility

$1,475.15

Service Code	HCPCS 36140
Hospital Charge Code	66528671
Hospital Revenue Code	360
Min. Negotiated Rate	$114.72
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.72
Rate for Payer: Aetna Government	$114.72
Rate for Payer: Brighton Health Commercial	$1,106.36
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	$737.58
Rate for Payer: Group Health Inc Medicare	$516.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$737.58
Rate for Payer: Hamaspik Choice Inc Medicare	$737.58
Rate for Payer: United Healthcare Commercial	$1,113.00

CC OMNIPAQUE 250ML

Facility

$1.96

Hospital Charge Code	66526102
Hospital Revenue Code	255
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

CC OMNIPAQUE 350MG/ML 100ML

Facility

$1.96

Service Code	HCPCS Q9967
Hospital Charge Code	66526104
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.13
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.15
Rate for Payer: SOMOS Essential	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.27

CC OMNIPAQUE 350MG/ML 100ML

Facility

$1.96

Service Code	HCPCS Q9967
Hospital Charge Code	66526104
Hospital Revenue Code	636
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98

CC OMNIPAQUE 350MG/ML 50ML

Facility

$1.96

Service Code	HCPCS Q9967
Hospital Charge Code	66526103
Hospital Revenue Code	255
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$1.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.33
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
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	$1.27

CC OXYHEMOGLOBIN (Q2HB) MEASURED

Facility

$24.43

Service Code	HCPCS 82810
Hospital Charge Code	66526896
Hospital Revenue Code	300
Rate for Payer: Cash Price	$9.77

CC OXYHEMOGLOBIN (Q2HB) MEASURED

Facility

$24.43

Service Code	HCPCS 82810
Hospital Charge Code	66526896
Hospital Revenue Code	300
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$18.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.77
Rate for Payer: Aetna Government	$9.77
Rate for Payer: Affinity Essential Plan 1&2	$6.84
Rate for Payer: Affinity Essential Plan 3&4	$6.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.84
Rate for Payer: Brighton Health Commercial	$18.32
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cash Price	$9.77
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.74
Rate for Payer: Elderplan Medicare Advantage	$9.77
Rate for Payer: EmblemHealth Commercial	$9.77
Rate for Payer: Fidelis Essential Plan Aliesa	$8.30
Rate for Payer: Fidelis Essential Plan QHP	$8.70
Rate for Payer: Fidelis Medicare Advantage	$9.77
Rate for Payer: Fidelis Qualified Health Plan	$8.70
Rate for Payer: Group Health Inc Commercial	$9.77
Rate for Payer: Group Health Inc Medicare	$9.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.22
Rate for Payer: Hamaspik Choice Inc Medicare	$9.77
Rate for Payer: Healthfirst Medicare Advantage	$9.77
Rate for Payer: Healthfirst QHP	$9.77
Rate for Payer: Humana Medicare	$9.97
Rate for Payer: Senior Whole Health Medicare Advantage	$9.77
Rate for Payer: United Healthcare Commercial	$11.05
Rate for Payer: United Healthcare Medicare Advantage	$9.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7.82
Rate for Payer: Wellcare Medicare	$8.79

CC PACEMAKER CATHETER

Facility

$226.00

Hospital Charge Code	66529922
Hospital Revenue Code	480
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$124.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$113.00
Rate for Payer: Aetna Government	$113.00
Rate for Payer: Brighton Health Commercial	$169.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$153.68
Rate for Payer: Group Health Inc Commercial	$113.00
Rate for Payer: Group Health Inc Medicare	$79.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.00
Rate for Payer: Hamaspik Choice Inc Medicare	$113.00
Rate for Payer: United Healthcare Commercial	$316.00

CC PACER POCKET REVISION

Facility

$4,914.88

Service Code	HCPCS 33222
Hospital Charge Code	66528639
Hospital Revenue Code	360
Min. Negotiated Rate	$1,409.00
Max. Negotiated Rate	$3,686.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,108.87
Rate for Payer: Aetna Government	$2,108.87
Rate for Payer: Affinity Essential Plan 1&2	$1,476.21
Rate for Payer: Affinity Essential Plan 3&4	$1,476.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,476.21
Rate for Payer: Brighton Health Commercial	$3,686.16
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Cash Price	$2,108.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,108.87
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	$2,108.87
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,792.54
Rate for Payer: Fidelis Essential Plan QHP	$1,876.89
Rate for Payer: Fidelis Medicare Advantage	$2,108.87
Rate for Payer: Fidelis Qualified Health Plan	$1,876.89
Rate for Payer: Group Health Inc Commercial	$2,108.87
Rate for Payer: Group Health Inc Medicare	$2,108.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,457.44
Rate for Payer: Hamaspik Choice Inc Medicare	$2,108.87
Rate for Payer: Healthfirst Medicare Advantage	$1,792.54
Rate for Payer: Healthfirst QHP	$2,108.87
Rate for Payer: Humana Medicare	$2,151.05
Rate for Payer: Senior Whole Health Medicare Advantage	$2,108.87
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$2,108.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,108.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,687.10
Rate for Payer: Wellcare Medicare	$2,003.43

CC PACER POCKET REVISION

Facility

$4,914.88

Service Code	HCPCS 33222
Hospital Charge Code	66528639
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,108.87

CCP ANTIBODIES IGG/IGA

Facility

$32.38

Service Code	HCPCS 86200
Hospital Charge Code	40729328
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.95

CCP ANTIBODIES IGG/IGA

Facility

$32.38

Service Code	HCPCS 86200
Hospital Charge Code	40729328
Hospital Revenue Code	300
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$24.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.95
Rate for Payer: Aetna Government	$12.95
Rate for Payer: Affinity Essential Plan 1&2	$9.06
Rate for Payer: Affinity Essential Plan 3&4	$9.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.06
Rate for Payer: Brighton Health Commercial	$24.28
Rate for Payer: Cash Price	$12.95
Rate for Payer: Cash Price	$12.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.95
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	$12.95
Rate for Payer: EmblemHealth Commercial	$12.95
Rate for Payer: Fidelis Essential Plan Aliesa	$11.01
Rate for Payer: Fidelis Essential Plan QHP	$11.53
Rate for Payer: Fidelis Medicare Advantage	$12.95
Rate for Payer: Fidelis Qualified Health Plan	$11.53
Rate for Payer: Group Health Inc Commercial	$12.95
Rate for Payer: Group Health Inc Medicare	$12.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.19
Rate for Payer: Hamaspik Choice Inc Medicare	$12.95
Rate for Payer: Healthfirst Medicare Advantage	$12.95
Rate for Payer: Healthfirst QHP	$12.95
Rate for Payer: Humana Medicare	$13.21
Rate for Payer: Senior Whole Health Medicare Advantage	$12.95
Rate for Payer: United Healthcare Commercial	$16.40
Rate for Payer: United Healthcare Medicare Advantage	$12.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.36
Rate for Payer: Wellcare Medicare	$11.66

Know your out-of-pocket cost for care.

All Charges