St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CONTACT TRIAL LEAD KIT

Facility

$1,875.00

Hospital Charge Code	64905860
Hospital Revenue Code	270
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,031.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$937.50
Rate for Payer: Aetna Government	$937.50
Rate for Payer: Brighton Health Commercial	$1,406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,275.00
Rate for Payer: Group Health Inc Commercial	$937.50
Rate for Payer: Group Health Inc Medicare	$656.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$937.50

CONTAINER EVACUATED,500ML

Facility

$10.54

Hospital Charge Code	64901114
Hospital Revenue Code	270
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$8.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.27
Rate for Payer: Aetna Government	$5.27
Rate for Payer: Brighton Health Commercial	$7.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.17
Rate for Payer: Group Health Inc Commercial	$5.27
Rate for Payer: Group Health Inc Medicare	$3.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.27
Rate for Payer: Hamaspik Choice Inc Medicare	$5.27

CONTAINER,GRADUATED,TRI I/O

Facility

$0.52

Hospital Charge Code	64902031
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26

CONTAINER,SPECIMEN,OR STERIL

Facility

$0.95

Hospital Charge Code	64904801
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48

CONTAINER,SPECIMEN,URIN 24HR

Facility

$5.80

Hospital Charge Code	64902022
Hospital Revenue Code	270
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.90
Rate for Payer: Aetna Government	$2.90
Rate for Payer: Brighton Health Commercial	$4.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.94
Rate for Payer: Group Health Inc Commercial	$2.90
Rate for Payer: Group Health Inc Medicare	$2.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.90
Rate for Payer: Hamaspik Choice Inc Medicare	$2.90

CONTINOUS VENTILATION, FIRST DAY

Facility

$1,483.00

Service Code	HCPCS 94002
Hospital Charge Code	40301500
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$1,112.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$815.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$724.69
Rate for Payer: Aetna Government	$724.69
Rate for Payer: Affinity Essential Plan 1&2	$507.28
Rate for Payer: Affinity Essential Plan 3&4	$507.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$507.28
Rate for Payer: Brighton Health Commercial	$1,112.25
Rate for Payer: Cash Price	$724.69
Rate for Payer: Cash Price	$724.69
Rate for Payer: Cash Price	$724.69
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$724.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$724.69
Rate for Payer: EmblemHealth Commercial	$724.69
Rate for Payer: Fidelis Essential Plan Aliesa	$615.99
Rate for Payer: Fidelis Essential Plan QHP	$644.97
Rate for Payer: Fidelis Medicare Advantage	$724.69
Rate for Payer: Fidelis Qualified Health Plan	$644.97
Rate for Payer: Group Health Inc Commercial	$724.69
Rate for Payer: Group Health Inc Medicare	$724.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$741.50
Rate for Payer: Hamaspik Choice Inc Medicare	$724.69
Rate for Payer: Healthfirst Medicare Advantage	$615.99
Rate for Payer: Healthfirst QHP	$724.69
Rate for Payer: Humana Medicare	$739.18
Rate for Payer: Senior Whole Health Medicare Advantage	$724.69
Rate for Payer: United Healthcare Commercial	$741.50
Rate for Payer: United Healthcare Medicare Advantage	$724.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$724.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$579.75
Rate for Payer: Wellcare Medicare	$688.46

CONTINOUS VENTILATION, FIRST DAY

Facility

$1,483.00

Service Code	HCPCS 94002
Hospital Charge Code	40301500
Hospital Revenue Code	410
Rate for Payer: Cash Price	$724.69

CONTINOUS VENT, SUBSEQUENT DAYS

Facility

$1,483.00

Service Code	HCPCS 94003
Hospital Charge Code	40307410
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$1,112.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$815.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$724.69
Rate for Payer: Aetna Government	$724.69
Rate for Payer: Affinity Essential Plan 1&2	$507.28
Rate for Payer: Affinity Essential Plan 3&4	$507.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$507.28
Rate for Payer: Brighton Health Commercial	$1,112.25
Rate for Payer: Cash Price	$724.69
Rate for Payer: Cash Price	$724.69
Rate for Payer: Cash Price	$724.69
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$724.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$724.69
Rate for Payer: EmblemHealth Commercial	$724.69
Rate for Payer: Fidelis Essential Plan Aliesa	$615.99
Rate for Payer: Fidelis Essential Plan QHP	$644.97
Rate for Payer: Fidelis Medicare Advantage	$724.69
Rate for Payer: Fidelis Qualified Health Plan	$644.97
Rate for Payer: Group Health Inc Commercial	$724.69
Rate for Payer: Group Health Inc Medicare	$724.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$741.50
Rate for Payer: Hamaspik Choice Inc Medicare	$724.69
Rate for Payer: Healthfirst Medicare Advantage	$615.99
Rate for Payer: Healthfirst QHP	$724.69
Rate for Payer: Humana Medicare	$739.18
Rate for Payer: Senior Whole Health Medicare Advantage	$724.69
Rate for Payer: United Healthcare Commercial	$741.50
Rate for Payer: United Healthcare Medicare Advantage	$724.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$724.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$579.75
Rate for Payer: Wellcare Medicare	$688.46

CONTINOUS VENT, SUBSEQUENT DAYS

Facility

$1,483.00

Service Code	HCPCS 94003
Hospital Charge Code	40307410
Hospital Revenue Code	410
Rate for Payer: Cash Price	$724.69

CONTINUUM CLUSTER-HOLE SHELL 52II

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40007530
Hospital Revenue Code	278
Min. Negotiated Rate	$2,984.00
Max. Negotiated Rate	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00

CONTINUUM CLUSTER-HOLE SHELL 52II

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40007530
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,266.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,282.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,580.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,984.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,431.60
Rate for Payer: EmblemHealth Commercial	$2,984.00
Rate for Payer: Fidelis Medicare Advantage	$6,266.40
Rate for Payer: Group Health Inc Commercial	$2,984.00
Rate for Payer: Group Health Inc Medicare	$2,088.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,879.20

CONTINUUM CLUSTER-HOLE SHELL 52II

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40204611
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,266.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,282.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,580.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,984.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,431.60
Rate for Payer: EmblemHealth Commercial	$2,984.00
Rate for Payer: Fidelis Medicare Advantage	$6,266.40
Rate for Payer: Group Health Inc Commercial	$2,984.00
Rate for Payer: Group Health Inc Medicare	$2,088.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,879.20

CONTINUUM CLUSTER-HOLE SHELL 52II

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40204611
Hospital Revenue Code	278
Min. Negotiated Rate	$2,984.00
Max. Negotiated Rate	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00

CONTINUUM CLUSTER-HOLE SHELL 54JJ

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40007528
Hospital Revenue Code	278
Min. Negotiated Rate	$2,984.00
Max. Negotiated Rate	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00

CONTINUUM CLUSTER-HOLE SHELL 54JJ

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40007528
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,266.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,282.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,580.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,984.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,431.60
Rate for Payer: EmblemHealth Commercial	$2,984.00
Rate for Payer: Fidelis Medicare Advantage	$6,266.40
Rate for Payer: Group Health Inc Commercial	$2,984.00
Rate for Payer: Group Health Inc Medicare	$2,088.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,879.20

CONTINUUM CLUSTER-HOLE SHELL 54JJ

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40204609
Hospital Revenue Code	278
Min. Negotiated Rate	$2,984.00
Max. Negotiated Rate	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00

CONTINUUM CLUSTER-HOLE SHELL 54JJ

Facility

$5,968.00

Service Code	HCPCS C1776
Hospital Charge Code	40204609
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,266.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,282.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,580.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,984.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,431.60
Rate for Payer: EmblemHealth Commercial	$2,984.00
Rate for Payer: Fidelis Medicare Advantage	$6,266.40
Rate for Payer: Group Health Inc Commercial	$2,984.00
Rate for Payer: Group Health Inc Medicare	$2,088.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,984.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,984.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,879.20

CONTOUR CURVED CUTTER STAPLER

Facility

$1,124.63

Hospital Charge Code	64905448
Hospital Revenue Code	270
Min. Negotiated Rate	$393.62
Max. Negotiated Rate	$899.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$562.32
Rate for Payer: Aetna Government	$562.32
Rate for Payer: Brighton Health Commercial	$843.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$899.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$764.75
Rate for Payer: Group Health Inc Commercial	$562.32
Rate for Payer: Group Health Inc Medicare	$393.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.32
Rate for Payer: Hamaspik Choice Inc Medicare	$562.32

CONTQCT LENWFITTING FOR FX

Facility

$96.12

Service Code	HCPCS 92071
Hospital Charge Code	30305959
Hospital Revenue Code	510
Min. Negotiated Rate	$28.59
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.59
Rate for Payer: Aetna Government	$28.59
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$48.06
Rate for Payer: Hamaspik Choice Inc Medicare	$48.06
Rate for Payer: United Healthcare Commercial	$222.00

Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure)

Facility

$2,915.00

Service Code	CPT 49424
Hospital Revenue Code	361
Min. Negotiated Rate	$43.32
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.32
Rate for Payer: Aetna Government	$43.32
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: United Healthcare Commercial	$1,113.00

Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report

Facility

$2,915.00

Service Code	CPT 49465
Hospital Revenue Code	361
Min. Negotiated Rate	$198.36
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
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	$283.37
Rate for Payer: EmblemHealth Commercial	$283.37
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report

Facility

$2,915.00

Service Code	CPT 36598
Hospital Revenue Code	361
Min. Negotiated Rate	$173.51
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$247.87
Rate for Payer: Aetna Government	$247.87
Rate for Payer: Affinity Essential Plan 1&2	$173.51
Rate for Payer: Affinity Essential Plan 3&4	$173.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$173.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$247.87
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	$247.87
Rate for Payer: EmblemHealth Commercial	$247.87
Rate for Payer: Fidelis Essential Plan Aliesa	$210.69
Rate for Payer: Fidelis Essential Plan QHP	$220.60
Rate for Payer: Fidelis Medicare Advantage	$247.87
Rate for Payer: Fidelis Qualified Health Plan	$220.60
Rate for Payer: Group Health Inc Commercial	$247.87
Rate for Payer: Group Health Inc Medicare	$247.87
Rate for Payer: Hamaspik Choice Inc Medicare	$247.87
Rate for Payer: Healthfirst Medicare Advantage	$210.69
Rate for Payer: Healthfirst QHP	$247.87
Rate for Payer: Humana Medicare	$252.83
Rate for Payer: Senior Whole Health Medicare Advantage	$247.87
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$247.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$198.30
Rate for Payer: Wellcare Medicare	$235.48

CONTRAST X-RAY EXAM OF COLON LVL1

Facility

$551.90

Service Code	HCPCS 74283 TC
Hospital Charge Code	30101157
Hospital Revenue Code	320
Min. Negotiated Rate	$146.86
Max. Negotiated Rate	$303.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.47
Rate for Payer: Aetna Government	$212.47
Rate for Payer: Affinity Essential Plan 1&2	$148.73
Rate for Payer: Affinity Essential Plan 3&4	$148.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$148.73
Rate for Payer: Brighton Health Commercial	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.86
Rate for Payer: Elderplan Medicare Advantage	$212.47
Rate for Payer: EmblemHealth Commercial	$148.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$180.60
Rate for Payer: Fidelis Essential Plan Aliesa	$180.60
Rate for Payer: Fidelis Essential Plan QHP	$189.10
Rate for Payer: Fidelis Medicare Advantage	$212.47
Rate for Payer: Fidelis Qualified Health Plan	$189.10
Rate for Payer: Group Health Inc Commercial	$191.22
Rate for Payer: Group Health Inc Medicare	$191.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$212.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.22
Rate for Payer: Healthfirst Medicare Advantage	$212.47
Rate for Payer: Healthfirst QHP	$212.47
Rate for Payer: Humana Medicare	$216.72
Rate for Payer: Senior Whole Health Medicare Advantage	$212.47
Rate for Payer: United Healthcare Medicare Advantage	$212.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.98
Rate for Payer: Wellcare Medicare	$201.85

CONTRAST X-RAY EXAM OF COLON LVL1

Facility

$551.90

Service Code	HCPCS 74283 TC
Hospital Charge Code	30101157
Hospital Revenue Code	320
Rate for Payer: Cash Price	$212.47

CONTROL, CA/CB/CC

Facility

$249.85

Hospital Charge Code	64903564
Hospital Revenue Code	270
Min. Negotiated Rate	$87.45
Max. Negotiated Rate	$199.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$124.92
Rate for Payer: Aetna Government	$124.92
Rate for Payer: Brighton Health Commercial	$187.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$199.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$169.90
Rate for Payer: Group Health Inc Commercial	$124.92
Rate for Payer: Group Health Inc Medicare	$87.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$124.92
Rate for Payer: Hamaspik Choice Inc Medicare	$124.92

Know your out-of-pocket cost for care.

All Charges