St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CROWN-RESIN-LABORATORY

Facility

$725.00

Service Code	HCPCS D2710
Hospital Charge Code	42300520
Hospital Revenue Code	361
Min. Negotiated Rate	$362.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$398.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$543.75
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$362.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

CROWN-RESIN-LABORATORY

Facility

$725.00

Service Code	HCPCS D2710
Hospital Charge Code	42300520
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

CROWN-RESIN WITH HIGH NOBLE METAL

Facility

$1,250.00

Service Code	HCPCS D2720
Hospital Charge Code	42300530
Hospital Revenue Code	361
Min. Negotiated Rate	$625.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$937.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

CROWN-RESIN WITH HIGH NOBLE METAL

Facility

$1,250.00

Service Code	HCPCS D2720
Hospital Charge Code	42300530
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

CROWN-RESIN WITH NOBLE METAL

Facility

$1,250.00

Service Code	HCPCS D2722
Hospital Charge Code	42300540
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

CROWN-RESIN WITH NOBLE METAL

Facility

$1,250.00

Service Code	HCPCS D2722
Hospital Charge Code	42300540
Hospital Revenue Code	361
Min. Negotiated Rate	$625.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$937.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

CROWN-RESIN WITH PREDOMINANTLY BA

Facility

$1,250.00

Service Code	HCPCS D2721
Hospital Charge Code	42300535
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

CROWN-RESIN WITH PREDOMINANTLY BA

Facility

$1,250.00

Service Code	HCPCS D2721
Hospital Charge Code	42300535
Hospital Revenue Code	361
Min. Negotiated Rate	$625.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$937.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

CROWN-RETAINER 3/4 CAST HIGH NOBL

Facility

$1,000.00

Service Code	HCPCS D6780
Hospital Charge Code	42301560
Hospital Revenue Code	361
Min. Negotiated Rate	$310.41
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$310.41
Rate for Payer: Aetna Government	$310.41
Rate for Payer: Brighton Health Commercial	$750.00
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: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

CROWN-RETAINER-FULL CAST HIGH NOB

Facility

$1,250.00

Service Code	HCPCS D6790
Hospital Charge Code	42301565
Hospital Revenue Code	361
Min. Negotiated Rate	$317.64
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$317.64
Rate for Payer: Aetna Government	$317.64
Rate for Payer: Brighton Health Commercial	$937.50
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: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00

CROWN-RETAINER-FULL CAST NOBLE ME

Facility

$1,250.00

Service Code	HCPCS D6792
Hospital Charge Code	42301575
Hospital Revenue Code	361
Min. Negotiated Rate	$312.20
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.20
Rate for Payer: Aetna Government	$312.20
Rate for Payer: Brighton Health Commercial	$937.50
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: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00

CROWN-RETAINER-FULL CAST PREDOM.

Facility

$1,250.00

Service Code	HCPCS D6791
Hospital Charge Code	42301570
Hospital Revenue Code	361
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$300.90
Rate for Payer: Aetna Government	$300.90
Rate for Payer: Brighton Health Commercial	$937.50
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: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00

CROWN-RETAINER-PORCELAIN FUSED HI

Facility

$1,250.00

Service Code	HCPCS D6750
Hospital Charge Code	42301545
Hospital Revenue Code	361
Min. Negotiated Rate	$328.79
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$328.79
Rate for Payer: Aetna Government	$328.79
Rate for Payer: Brighton Health Commercial	$937.50
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: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00

CROWN-RETAINER-PORCELAIN FUSED PR

Facility

$1,250.00

Service Code	HCPCS D6751
Hospital Charge Code	42301550
Hospital Revenue Code	361
Min. Negotiated Rate	$307.45
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$307.45
Rate for Payer: Aetna Government	$307.45
Rate for Payer: Brighton Health Commercial	$937.50
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: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00

CROWN-RETAINER-PORCELAIN FUSED TO

Facility

$1,250.00

Service Code	HCPCS D6752
Hospital Charge Code	42301555
Hospital Revenue Code	361
Min. Negotiated Rate	$314.69
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$314.69
Rate for Payer: Aetna Government	$314.69
Rate for Payer: Brighton Health Commercial	$937.50
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: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00

CROWN-RETAINER-RESIN WITH NOBLE M

Facility

$1,250.00

Service Code	HCPCS D6722
Hospital Charge Code	42301540
Hospital Revenue Code	361
Min. Negotiated Rate	$310.41
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$310.41
Rate for Payer: Aetna Government	$310.41
Rate for Payer: Brighton Health Commercial	$937.50
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: Group Health Inc Commercial	$625.00
Rate for Payer: Group Health Inc Medicare	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$625.00

CROWN-TITANIUM AND TITANIUM ALLOY

Facility

$1,250.00

Service Code	HCPCS D2794
Hospital Charge Code	42300719
Hospital Revenue Code	361
Min. Negotiated Rate	$625.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$687.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$937.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
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	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

CROWN-TITANIUM AND TITANIUM ALLOY

Facility

$1,250.00

Service Code	HCPCS D2794
Hospital Charge Code	42300719
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

CRTD DTMB1D1 AMPLIA

Facility

$52,900.00

Service Code	HCPCS C1889
Hospital Charge Code	64907324
Hospital Revenue Code	278
Min. Negotiated Rate	$26,450.00
Max. Negotiated Rate	$26,450.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26,450.00

CRTD DTMB1D1 AMPLIA

Facility

$52,900.00

Service Code	HCPCS C1889
Hospital Charge Code	64907324
Hospital Revenue Code	278
Min. Negotiated Rate	$18,515.00
Max. Negotiated Rate	$55,545.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29,095.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26,450.00
Rate for Payer: Aetna Government	$26,450.00
Rate for Payer: Brighton Health Commercial	$31,740.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26,450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$30,417.50
Rate for Payer: EmblemHealth Commercial	$26,450.00
Rate for Payer: Fidelis Medicare Advantage	$55,545.00
Rate for Payer: Group Health Inc Commercial	$26,450.00
Rate for Payer: Group Health Inc Medicare	$18,515.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$26,450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34,385.00

CRUCIATE RETAINING 14MM

Facility

$4,192.63

Hospital Charge Code	64906057
Hospital Revenue Code	270
Min. Negotiated Rate	$1,467.42
Max. Negotiated Rate	$3,354.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,305.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,096.32
Rate for Payer: Aetna Government	$2,096.32
Rate for Payer: Brighton Health Commercial	$3,144.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,354.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,850.99
Rate for Payer: Group Health Inc Commercial	$2,096.32
Rate for Payer: Group Health Inc Medicare	$1,467.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32

CRYOCAUTERY OF CERVIX

Facility

$819.95

Service Code	HCPCS 57511
Hospital Charge Code	30301250
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$370.99
Rate for Payer: Aetna Government	$370.99
Rate for Payer: Affinity Essential Plan 1&2	$259.69
Rate for Payer: Affinity Essential Plan 3&4	$259.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$259.69
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$370.99
Rate for Payer: Cash Price	$370.99
Rate for Payer: Cash Price	$370.99
Rate for Payer: Cash Price	$370.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$370.99
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	$370.99
Rate for Payer: Fidelis Essential Plan Aliesa	$315.34
Rate for Payer: Fidelis Essential Plan QHP	$330.18
Rate for Payer: Fidelis Medicare Advantage	$370.99
Rate for Payer: Fidelis Qualified Health Plan	$330.18
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	$409.98
Rate for Payer: Hamaspik Choice Inc Medicare	$370.99
Rate for Payer: Healthfirst Medicare Advantage	$315.34
Rate for Payer: Healthfirst QHP	$370.99
Rate for Payer: Humana Medicare	$378.41
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$370.99
Rate for Payer: Senior Whole Health Medicare Advantage	$370.99
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$370.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$370.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$296.79
Rate for Payer: Wellcare Medicare	$352.44

CRYOCAUTERY OF CERVIX

Facility

$819.95

Service Code	HCPCS 57511
Hospital Charge Code	30301250
Hospital Revenue Code	510
Rate for Payer: Cash Price	$370.99

CRYOGLOBULIN, QI, SERUM

Facility

$16.18

Service Code	HCPCS 82595
Hospital Charge Code	40609063
Hospital Revenue Code	300
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$12.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.47
Rate for Payer: Aetna Government	$6.47
Rate for Payer: Affinity Essential Plan 1&2	$4.53
Rate for Payer: Affinity Essential Plan 3&4	$4.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.53
Rate for Payer: Brighton Health Commercial	$12.14
Rate for Payer: Cash Price	$6.47
Rate for Payer: Cash Price	$6.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.70
Rate for Payer: Elderplan Medicare Advantage	$6.47
Rate for Payer: EmblemHealth Commercial	$6.47
Rate for Payer: Fidelis Essential Plan Aliesa	$5.50
Rate for Payer: Fidelis Essential Plan QHP	$5.76
Rate for Payer: Fidelis Medicare Advantage	$6.47
Rate for Payer: Fidelis Qualified Health Plan	$5.76
Rate for Payer: Group Health Inc Commercial	$6.47
Rate for Payer: Group Health Inc Medicare	$6.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.09
Rate for Payer: Hamaspik Choice Inc Medicare	$6.47
Rate for Payer: Healthfirst Medicare Advantage	$6.47
Rate for Payer: Healthfirst QHP	$6.47
Rate for Payer: Humana Medicare	$6.60
Rate for Payer: Senior Whole Health Medicare Advantage	$6.47
Rate for Payer: United Healthcare Commercial	$8.20
Rate for Payer: United Healthcare Medicare Advantage	$6.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.18
Rate for Payer: Wellcare Medicare	$5.82

CRYOGLOBULIN, QI, SERUM

Facility

$16.18

Service Code	HCPCS 82595
Hospital Charge Code	40609063
Hospital Revenue Code	300
Rate for Payer: Cash Price	$6.47

Know your out-of-pocket cost for care.

All Charges