St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CC R&L HRT CATH CHD ABNL NT CNJ

Facility

$8,926.00

Service Code	HCPCS 93597
Hospital Charge Code	66521519
Hospital Revenue Code	481
Min. Negotiated Rate	$2,637.79
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,909.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,768.27
Rate for Payer: Aetna Government	$3,768.27
Rate for Payer: Affinity Essential Plan 1&2	$2,637.79
Rate for Payer: Affinity Essential Plan 3&4	$2,637.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,637.79
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,768.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: Elderplan Medicare Advantage	$3,768.27
Rate for Payer: EmblemHealth Commercial	$3,768.27
Rate for Payer: Fidelis Essential Plan Aliesa	$3,203.03
Rate for Payer: Fidelis Essential Plan QHP	$3,353.76
Rate for Payer: Fidelis Medicare Advantage	$3,768.27
Rate for Payer: Fidelis Qualified Health Plan	$3,353.76
Rate for Payer: Group Health Inc Commercial	$3,768.27
Rate for Payer: Group Health Inc Medicare	$3,768.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,463.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,768.27
Rate for Payer: Healthfirst Medicare Advantage	$3,203.03
Rate for Payer: Healthfirst QHP	$3,768.27
Rate for Payer: Humana Medicare	$3,843.64
Rate for Payer: Senior Whole Health Medicare Advantage	$3,768.27
Rate for Payer: United Healthcare Medicare Advantage	$3,768.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,768.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,014.62
Rate for Payer: Wellcare Medicare	$3,579.86

CC R&L HRT CATH CHD NML NT CNJ

Facility

$8,926.00

Service Code	HCPCS 93596
Hospital Charge Code	66521518
Hospital Revenue Code	481
Min. Negotiated Rate	$2,637.79
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,909.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,768.27
Rate for Payer: Aetna Government	$3,768.27
Rate for Payer: Affinity Essential Plan 1&2	$2,637.79
Rate for Payer: Affinity Essential Plan 3&4	$2,637.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,637.79
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,768.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: Elderplan Medicare Advantage	$3,768.27
Rate for Payer: EmblemHealth Commercial	$3,768.27
Rate for Payer: Fidelis Essential Plan Aliesa	$3,203.03
Rate for Payer: Fidelis Essential Plan QHP	$3,353.76
Rate for Payer: Fidelis Medicare Advantage	$3,768.27
Rate for Payer: Fidelis Qualified Health Plan	$3,353.76
Rate for Payer: Group Health Inc Commercial	$3,768.27
Rate for Payer: Group Health Inc Medicare	$3,768.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,463.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,768.27
Rate for Payer: Healthfirst Medicare Advantage	$3,203.03
Rate for Payer: Healthfirst QHP	$3,768.27
Rate for Payer: Humana Medicare	$3,843.64
Rate for Payer: Senior Whole Health Medicare Advantage	$3,768.27
Rate for Payer: United Healthcare Medicare Advantage	$3,768.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,768.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,014.62
Rate for Payer: Wellcare Medicare	$3,579.86

CC R&L HRT CATH CHD NML NT CNJ

Facility

$8,926.00

Service Code	HCPCS 93596
Hospital Charge Code	66521518
Hospital Revenue Code	481
Rate for Payer: Cash Price	$3,768.27

CC R&L HRT CATH W/VENTRICLGRPHY

Facility

$8,631.78

Service Code	HCPCS 93453 TC
Hospital Charge Code	66528893
Hospital Revenue Code	481
Min. Negotiated Rate	$2,637.79
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,387.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,768.27
Rate for Payer: Aetna Government	$3,768.27
Rate for Payer: Affinity Essential Plan 1&2	$2,637.79
Rate for Payer: Affinity Essential Plan 3&4	$2,637.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,637.79
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Cash Price	$3,768.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,768.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,215.78
Rate for Payer: Elderplan Medicare Advantage	$3,768.27
Rate for Payer: EmblemHealth Commercial	$3,768.27
Rate for Payer: Fidelis Essential Plan Aliesa	$3,203.03
Rate for Payer: Fidelis Essential Plan QHP	$3,353.76
Rate for Payer: Fidelis Medicare Advantage	$3,768.27
Rate for Payer: Fidelis Qualified Health Plan	$3,353.76
Rate for Payer: Group Health Inc Commercial	$3,768.27
Rate for Payer: Group Health Inc Medicare	$3,768.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,315.89
Rate for Payer: Hamaspik Choice Inc Medicare	$3,768.27
Rate for Payer: Healthfirst Medicare Advantage	$3,203.03
Rate for Payer: Healthfirst QHP	$3,768.27
Rate for Payer: Humana Medicare	$3,843.64
Rate for Payer: Senior Whole Health Medicare Advantage	$3,768.27
Rate for Payer: United Healthcare Commercial	$3,955.00
Rate for Payer: United Healthcare Medicare Advantage	$3,768.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,768.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,014.62
Rate for Payer: Wellcare Medicare	$3,579.86

CC R&L HRT CATH W/VENTRICLGRPHY

Facility

$8,631.78

Service Code	HCPCS 93453 TC
Hospital Charge Code	66528893
Hospital Revenue Code	481
Rate for Payer: Cash Price	$3,768.27

CC SAFE SHEATH 9 FR TEAR-AWAY VLV

Facility

$78.00

Service Code	HCPCS C1894
Hospital Charge Code	66526878
Hospital Revenue Code	278
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00
Rate for Payer: Hamaspik Choice Inc Medicare	$39.00

CC SAFE SHEATH 9 FR TEAR-AWAY VLV

Facility

$78.00

Service Code	HCPCS C1894
Hospital Charge Code	66526878
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$81.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$46.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.85
Rate for Payer: EmblemHealth Commercial	$39.00
Rate for Payer: Fidelis Medicare Advantage	$81.90
Rate for Payer: Group Health Inc Commercial	$39.00
Rate for Payer: Group Health Inc Medicare	$27.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00
Rate for Payer: Hamaspik Choice Inc Medicare	$39.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.70

CC SAFESHEATH TEAR AWAY

Facility

$75.00

Service Code	HCPCS C1894
Hospital Charge Code	66526882
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

CC SAFESHEATH TEAR AWAY

Facility

$75.00

Service Code	HCPCS C1894
Hospital Charge Code	66526882
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$78.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$45.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.12
Rate for Payer: EmblemHealth Commercial	$37.50
Rate for Payer: Fidelis Medicare Advantage	$78.75
Rate for Payer: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.75

CC SC/DC ICD GENERATOR CHANGE

Facility

$68,791.68

Service Code	HCPCS 33240
Hospital Charge Code	66528644
Hospital Revenue Code	360
Rate for Payer: Cash Price	$27,258.51

CC SC/DC ICD GENERATOR CHANGE

Facility

$68,791.68

Service Code	HCPCS 33240
Hospital Charge Code	66528644
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$51,593.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$44,507.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27,258.51
Rate for Payer: Aetna Government	$27,258.51
Rate for Payer: Affinity Essential Plan 1&2	$19,080.96
Rate for Payer: Affinity Essential Plan 3&4	$19,080.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,080.96
Rate for Payer: Brighton Health Commercial	$51,593.76
Rate for Payer: Cash Price	$27,258.51
Rate for Payer: Cash Price	$27,258.51
Rate for Payer: Cash Price	$27,258.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27,258.51
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	$27,258.51
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$23,169.73
Rate for Payer: Fidelis Essential Plan QHP	$24,260.07
Rate for Payer: Fidelis Medicare Advantage	$27,258.51
Rate for Payer: Fidelis Qualified Health Plan	$24,260.07
Rate for Payer: Group Health Inc Commercial	$27,258.51
Rate for Payer: Group Health Inc Medicare	$27,258.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,395.84
Rate for Payer: Hamaspik Choice Inc Medicare	$27,258.51
Rate for Payer: Healthfirst Medicare Advantage	$23,169.73
Rate for Payer: Healthfirst QHP	$27,258.51
Rate for Payer: Humana Medicare	$27,803.68
Rate for Payer: Senior Whole Health Medicare Advantage	$27,258.51
Rate for Payer: United Healthcare Commercial	$4,446.00
Rate for Payer: United Healthcare Medicare Advantage	$27,258.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27,258.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,806.81
Rate for Payer: Wellcare Medicare	$25,895.58

CC SCOPE EXAM OF LUNG, AIRWAY

Facility

$4,535.55

Service Code	HCPCS 31623
Hospital Charge Code	66521558
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,962.76

CC SCOPE EXAM OF LUNG, AIRWAY

Facility

$4,535.55

Service Code	HCPCS 31623
Hospital Charge Code	66521558
Hospital Revenue Code	361
Min. Negotiated Rate	$1,373.93
Max. Negotiated Rate	$3,401.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,962.76
Rate for Payer: Aetna Government	$1,962.76
Rate for Payer: Affinity Essential Plan 1&2	$1,373.93
Rate for Payer: Affinity Essential Plan 3&4	$1,373.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,373.93
Rate for Payer: Brighton Health Commercial	$3,401.66
Rate for Payer: Cash Price	$1,962.76
Rate for Payer: Cash Price	$1,962.76
Rate for Payer: Cash Price	$1,962.76
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,962.76
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	$1,962.76
Rate for Payer: EmblemHealth Commercial	$1,962.76
Rate for Payer: Fidelis Essential Plan Aliesa	$1,668.35
Rate for Payer: Fidelis Essential Plan QHP	$1,746.86
Rate for Payer: Fidelis Medicare Advantage	$1,962.76
Rate for Payer: Fidelis Qualified Health Plan	$1,746.86
Rate for Payer: Group Health Inc Commercial	$1,962.76
Rate for Payer: Group Health Inc Medicare	$1,962.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,267.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1,962.76
Rate for Payer: Healthfirst Medicare Advantage	$1,668.35
Rate for Payer: Healthfirst QHP	$1,962.76
Rate for Payer: Humana Medicare	$2,002.02
Rate for Payer: Senior Whole Health Medicare Advantage	$1,962.76
Rate for Payer: United Healthcare Commercial	$1,409.00
Rate for Payer: United Healthcare Medicare Advantage	$1,962.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,962.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,570.21
Rate for Payer: Wellcare Medicare	$1,864.62

CC SET INTRO 4FR MICROPUNCT

Facility

$72.20

Hospital Charge Code	66520127
Hospital Revenue Code	270
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$57.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.10
Rate for Payer: Aetna Government	$36.10
Rate for Payer: Brighton Health Commercial	$54.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.10
Rate for Payer: Group Health Inc Commercial	$36.10
Rate for Payer: Group Health Inc Medicare	$25.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.10
Rate for Payer: Hamaspik Choice Inc Medicare	$36.10

CC SHEATH COOK 4FR MICPUCTUR KIT

Facility

$72.20

Hospital Charge Code	66520279
Hospital Revenue Code	480
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.10
Rate for Payer: Aetna Government	$36.10
Rate for Payer: Brighton Health Commercial	$54.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.10
Rate for Payer: Group Health Inc Commercial	$36.10
Rate for Payer: Group Health Inc Medicare	$25.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.10
Rate for Payer: Hamaspik Choice Inc Medicare	$36.10
Rate for Payer: United Healthcare Commercial	$316.00

CC SHEATH COOK 5FR MICROPUNT KIT

Facility

$60.80

Hospital Charge Code	66520301
Hospital Revenue Code	270
Min. Negotiated Rate	$21.28
Max. Negotiated Rate	$48.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.40
Rate for Payer: Aetna Government	$30.40
Rate for Payer: Brighton Health Commercial	$45.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$41.34
Rate for Payer: Group Health Inc Commercial	$30.40
Rate for Payer: Group Health Inc Medicare	$21.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.40
Rate for Payer: Hamaspik Choice Inc Medicare	$30.40

CC SHEATH INTR 5F 074 10CM

Facility

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66520239
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$832.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$475.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.69
Rate for Payer: EmblemHealth Commercial	$396.25
Rate for Payer: Fidelis Medicare Advantage	$832.12
Rate for Payer: Group Health Inc Commercial	$396.25
Rate for Payer: Group Health Inc Medicare	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$515.12

CC SHEATH INTR 5F 074 10CM

Facility

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66520239
Hospital Revenue Code	278
Min. Negotiated Rate	$396.25
Max. Negotiated Rate	$396.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25

CC SHEATH INTR 5F 074 16CM

Facility

$365.00

Service Code	HCPCS C1894
Hospital Charge Code	66520200
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$383.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$219.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.88
Rate for Payer: EmblemHealth Commercial	$182.50
Rate for Payer: Fidelis Medicare Advantage	$383.25
Rate for Payer: Group Health Inc Commercial	$182.50
Rate for Payer: Group Health Inc Medicare	$127.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$237.25

CC SHEATH INTR 5F 074 16CM

Facility

$365.00

Service Code	HCPCS C1894
Hospital Charge Code	66520200
Hospital Revenue Code	278
Min. Negotiated Rate	$182.50
Max. Negotiated Rate	$182.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.50
Rate for Payer: Hamaspik Choice Inc Medicare	$182.50

CC SHEATHS 4F 10CM

Facility

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528796
Hospital Revenue Code	278
Min. Negotiated Rate	$396.25
Max. Negotiated Rate	$396.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25

CC SHEATHS 4F 10CM

Facility

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528796
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$832.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$475.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.69
Rate for Payer: EmblemHealth Commercial	$396.25
Rate for Payer: Fidelis Medicare Advantage	$832.12
Rate for Payer: Group Health Inc Commercial	$396.25
Rate for Payer: Group Health Inc Medicare	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$515.12

CC SHEATHS 5F 10CM

Facility

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528795
Hospital Revenue Code	278
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$832.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$475.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.69
Rate for Payer: EmblemHealth Commercial	$396.25
Rate for Payer: Fidelis Medicare Advantage	$832.12
Rate for Payer: Group Health Inc Commercial	$396.25
Rate for Payer: Group Health Inc Medicare	$277.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$515.12

CC SHEATHS 5F 10CM

Facility

$792.50

Service Code	HCPCS C1894
Hospital Charge Code	66528795
Hospital Revenue Code	278
Min. Negotiated Rate	$396.25
Max. Negotiated Rate	$396.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.25
Rate for Payer: Hamaspik Choice Inc Medicare	$396.25

CC SHEATH TERUMO 4FR PINNACLE10CM

Facility

$19.40

Service Code	HCPCS C1766
Hospital Charge Code	66520256
Hospital Revenue Code	278
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$9.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.70
Rate for Payer: Hamaspik Choice Inc Medicare	$9.70

Know your out-of-pocket cost for care.

All Charges