St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC OFFICE OUTPATIENT NEW 45-59 MINUTES

Facility

$503.00

Service Code	CPT 99204
Hospital Charge Code	5109920401
Hospital Revenue Code	510
Min. Negotiated Rate	$92.04
Max. Negotiated Rate	$276.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$276.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$92.04
Rate for Payer: Aetna Government	$92.04
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$251.50
Rate for Payer: Hamaspik Choice Inc Medicare	$251.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$149.04
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT NEW 45-59 MINUTES

Facility

$503.00

Service Code	CPT 99204
Hospital Charge Code	5109920401
Hospital Revenue Code	510
Min. Negotiated Rate	$251.50
Max. Negotiated Rate	$251.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$251.50

HC OFFICE OUTPATIENT NEW 60-74 MINUTES

Facility

$528.00

Service Code	CPT 99205
Hospital Charge Code	5109920501
Hospital Revenue Code	510
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$290.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$290.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$264.00
Rate for Payer: Hamaspik Choice Inc Medicare	$264.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$203.31
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT NEW 60-74 MINUTES

Facility

$528.00

Service Code	CPT 99205
Hospital Charge Code	5109920501
Hospital Revenue Code	510
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$264.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.00

HC OFFICE OUTPATIENT VISIT 10-19 MINUTES

Facility

$395.00

Service Code	CPT 99212
Hospital Charge Code	5109921201
Hospital Revenue Code	510
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.50
Rate for Payer: Aetna Government	$18.50
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$197.50
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38.85
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT VISIT 10-19 MINUTES

Facility

$395.00

Service Code	CPT 99212
Hospital Charge Code	5109921201
Hospital Revenue Code	510
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$197.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50

HC OFFICE OUTPATIENT VISIT 15-29 MINUTES

Facility

$415.00

Service Code	CPT 99213
Hospital Charge Code	5109921301
Hospital Revenue Code	510
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.90
Rate for Payer: Aetna Government	$39.90
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$207.50
Rate for Payer: Hamaspik Choice Inc Medicare	$207.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.09
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT VISIT 15-29 MINUTES

Facility

$415.00

Service Code	CPT 99213
Hospital Charge Code	5109921301
Hospital Revenue Code	510
Min. Negotiated Rate	$207.50
Max. Negotiated Rate	$207.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.50

HC OFFICE OUTPATIENT VISIT 25 MINUTES

Facility

$435.00

Service Code	CPT 99214
Hospital Charge Code	5109921401
Hospital Revenue Code	510
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$239.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.00
Rate for Payer: Aetna Government	$54.00
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$217.50
Rate for Payer: Hamaspik Choice Inc Medicare	$217.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$107.63
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT VISIT 25 MINUTES

Facility

$435.00

Service Code	CPT 99214
Hospital Charge Code	5109921401
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.50

HC OFFICE OUTPATIENT VISIT 40-54 MINUTES

Facility

$457.00

Service Code	CPT 99215
Hospital Charge Code	5109921501
Hospital Revenue Code	510
Min. Negotiated Rate	$80.96
Max. Negotiated Rate	$251.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$251.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.96
Rate for Payer: Aetna Government	$80.96
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
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	$228.50
Rate for Payer: Hamaspik Choice Inc Medicare	$228.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$159.12
Rate for Payer: United Healthcare Commercial	$222.00

HC OFFICE OUTPATIENT VISIT 40-54 MINUTES

Facility

$457.00

Service Code	CPT 99215
Hospital Charge Code	5109921501
Hospital Revenue Code	510
Min. Negotiated Rate	$228.50
Max. Negotiated Rate	$228.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$228.50

HC OFFICE OUTPATIENT VISIT 5 MINUTES

Facility

$395.00

Service Code	CPT 99211
Hospital Charge Code	5109921101
Hospital Revenue Code	510
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$2,020.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$217.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.70
Rate for Payer: Aetna Government	$6.70
Rate for Payer: Affinity Essential Plan 1&2	$45.45
Rate for Payer: Affinity Essential Plan 3&4	$45.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$20.20
Rate for Payer: Amida Care Medicaid	$20.20
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$45.45
Rate for Payer: EmblemHealth Essential Plan 3&4	$20.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20.20
Rate for Payer: Fidelis Essential Plan Aliesa	$45.45
Rate for Payer: Fidelis Essential Plan QHP	$45.45
Rate for Payer: Fidelis Qualified Health Plan	$21.21
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	$20.20
Rate for Payer: Hamaspik Choice Inc Medicare	$197.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,020.00
Rate for Payer: Healthfirst Essential Plan	$45.45
Rate for Payer: Healthfirst QHP	$32.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20.20
Rate for Payer: SOMOS Essential	$45.45
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$45.45
Rate for Payer: United Healthcare Essential Plan 3&4	$22.22
Rate for Payer: United Healthcare Medicaid	$20.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.20

HC OFFICE OUTPATIENT VISIT 5 MINUTES

Facility

$395.00

Service Code	CPT 99211
Hospital Charge Code	5109921101
Hospital Revenue Code	510
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$197.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.50

HC OLIGOCLONAL IMMUNOGLOBULIN - OLIGOCLONAL BANDING

Facility

$68.00

Service Code	CPT 83916
Hospital Charge Code	3018391601
Hospital Revenue Code	301
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$34.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.00

HC OLIGOCLONAL IMMUNOGLOBULIN - OLIGOCLONAL BANDING

Facility

$68.00

Service Code	CPT 83916
Hospital Charge Code	3018391601
Hospital Revenue Code	301
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$51.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.39
Rate for Payer: Aetna Government	$27.39
Rate for Payer: Affinity Essential Plan 1&2	$19.17
Rate for Payer: Affinity Essential Plan 3&4	$19.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$19.17
Rate for Payer: Brighton Health Commercial	$51.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.78
Rate for Payer: Elderplan Medicare Advantage	$27.39
Rate for Payer: EmblemHealth Commercial	$27.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24.65
Rate for Payer: Fidelis Essential Plan Aliesa	$23.28
Rate for Payer: Fidelis Essential Plan QHP	$24.38
Rate for Payer: Fidelis Medicare Advantage	$27.39
Rate for Payer: Fidelis Qualified Health Plan	$24.38
Rate for Payer: Group Health Inc Commercial	$27.39
Rate for Payer: Group Health Inc Medicare	$27.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.39
Rate for Payer: Hamaspik Choice Inc Medicare	$27.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.39
Rate for Payer: Healthfirst Medicare Advantage	$27.39
Rate for Payer: Healthfirst QHP	$27.39
Rate for Payer: Humana Medicare	$27.94
Rate for Payer: Senior Whole Health Medicare Advantage	$27.39
Rate for Payer: United Healthcare Commercial	$25.47
Rate for Payer: United Healthcare Medicare Advantage	$27.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$27.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.02
Rate for Payer: Wellcare Medicare	$24.65

HC OPEN RX DISTAL RADIUS FRAC, INTRA-ARTICULAR, 2 FRAG

Facility

$19,280.00

Service Code	CPT 25608
Hospital Charge Code	3612560801
Hospital Revenue Code	361
Min. Negotiated Rate	$989.51
Max. Negotiated Rate	$14,460.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,728.35
Rate for Payer: Aetna Government	$8,728.35
Rate for Payer: Affinity Essential Plan 1&2	$6,109.85
Rate for Payer: Affinity Essential Plan 3&4	$6,109.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$6,109.85
Rate for Payer: Brighton Health Commercial	$14,460.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,728.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$8,728.35
Rate for Payer: EmblemHealth Commercial	$8,728.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7,855.52
Rate for Payer: Fidelis Essential Plan Aliesa	$7,419.10
Rate for Payer: Fidelis Essential Plan QHP	$7,768.23
Rate for Payer: Fidelis Medicare Advantage	$8,728.35
Rate for Payer: Fidelis Qualified Health Plan	$7,768.23
Rate for Payer: Group Health Inc Commercial	$8,728.35
Rate for Payer: Group Health Inc Medicare	$8,728.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,728.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,764.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$989.51
Rate for Payer: Healthfirst Medicare Advantage	$7,419.10
Rate for Payer: Healthfirst QHP	$8,728.35
Rate for Payer: Humana Medicare	$8,902.92
Rate for Payer: Senior Whole Health Medicare Advantage	$8,728.35
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$8,728.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,728.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8,291.93
Rate for Payer: Wellcare Medicare	$8,291.93

HC OPEN RX DISTAL RADIUS FRAC, INTRA-ARTICULAR, 2 FRAG

Facility

$19,280.00

Service Code	CPT 25608
Hospital Charge Code	3612560801
Hospital Revenue Code	361
Min. Negotiated Rate	$9,640.00
Max. Negotiated Rate	$9,640.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,640.00

HC OPEN TX BIMALLEOLAR ANKLE FRACTURE, W/ MANIP

Facility

$18,117.00

Service Code	CPT 27814
Hospital Charge Code	3612781401
Hospital Revenue Code	361
Min. Negotiated Rate	$9,058.50
Max. Negotiated Rate	$9,058.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.50

HC OPEN TX BIMALLEOLAR ANKLE FRACTURE, W/ MANIP

Facility

$18,117.00

Service Code	CPT 27814
Hospital Charge Code	3612781401
Hospital Revenue Code	361
Min. Negotiated Rate	$905.19
Max. Negotiated Rate	$13,587.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,728.35
Rate for Payer: Aetna Government	$8,728.35
Rate for Payer: Affinity Essential Plan 1&2	$6,109.85
Rate for Payer: Affinity Essential Plan 3&4	$6,109.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$6,109.85
Rate for Payer: Brighton Health Commercial	$13,587.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,728.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$8,728.35
Rate for Payer: EmblemHealth Commercial	$8,728.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7,855.52
Rate for Payer: Fidelis Essential Plan Aliesa	$7,419.10
Rate for Payer: Fidelis Essential Plan QHP	$7,768.23
Rate for Payer: Fidelis Medicare Advantage	$8,728.35
Rate for Payer: Fidelis Qualified Health Plan	$7,768.23
Rate for Payer: Group Health Inc Commercial	$8,728.35
Rate for Payer: Group Health Inc Medicare	$8,728.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,728.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,567.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$905.19
Rate for Payer: Healthfirst Medicare Advantage	$7,419.10
Rate for Payer: Healthfirst QHP	$8,728.35
Rate for Payer: Humana Medicare	$8,902.92
Rate for Payer: Senior Whole Health Medicare Advantage	$8,728.35
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$8,728.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,728.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8,291.93
Rate for Payer: Wellcare Medicare	$8,291.93

HC OPEN TX DISTAL FIB FRAC W/INTERN FIXTN

Facility

$18,117.00

Service Code	CPT 27792
Hospital Charge Code	3612779201
Hospital Revenue Code	361
Min. Negotiated Rate	$763.19
Max. Negotiated Rate	$13,587.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,728.35
Rate for Payer: Aetna Government	$8,728.35
Rate for Payer: Affinity Essential Plan 1&2	$6,109.85
Rate for Payer: Affinity Essential Plan 3&4	$6,109.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$6,109.85
Rate for Payer: Brighton Health Commercial	$13,587.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,728.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$8,728.35
Rate for Payer: EmblemHealth Commercial	$8,728.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7,855.52
Rate for Payer: Fidelis Essential Plan Aliesa	$7,419.10
Rate for Payer: Fidelis Essential Plan QHP	$7,768.23
Rate for Payer: Fidelis Medicare Advantage	$8,728.35
Rate for Payer: Fidelis Qualified Health Plan	$7,768.23
Rate for Payer: Group Health Inc Commercial	$8,728.35
Rate for Payer: Group Health Inc Medicare	$8,728.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,728.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,596.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$763.19
Rate for Payer: Healthfirst Medicare Advantage	$7,419.10
Rate for Payer: Healthfirst QHP	$8,728.35
Rate for Payer: Humana Medicare	$8,902.92
Rate for Payer: Senior Whole Health Medicare Advantage	$8,728.35
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$8,728.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,728.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8,291.93
Rate for Payer: Wellcare Medicare	$8,291.93

HC OPEN TX DISTAL FIB FRAC W/INTERN FIXTN

Facility

$18,117.00

Service Code	CPT 27792
Hospital Charge Code	3612779201
Hospital Revenue Code	361
Min. Negotiated Rate	$9,058.50
Max. Negotiated Rate	$9,058.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.50

HC OPEN TX, FINGER FRACTURE, EACH

Facility

$8,291.00

Service Code	CPT 26765
Hospital Charge Code	3612676501
Hospital Revenue Code	361
Min. Negotiated Rate	$4,145.50
Max. Negotiated Rate	$4,145.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.50

HC OPEN TX, FINGER FRACTURE, EACH

Facility

$8,291.00

Service Code	CPT 26765
Hospital Charge Code	3612676501
Hospital Revenue Code	361
Min. Negotiated Rate	$606.24
Max. Negotiated Rate	$6,218.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,964.33
Rate for Payer: Aetna Government	$3,964.33
Rate for Payer: Affinity Essential Plan 1&2	$2,775.03
Rate for Payer: Affinity Essential Plan 3&4	$2,775.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,775.03
Rate for Payer: Brighton Health Commercial	$6,218.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,964.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$3,964.33
Rate for Payer: EmblemHealth Commercial	$3,964.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,567.90
Rate for Payer: Fidelis Essential Plan Aliesa	$3,369.68
Rate for Payer: Fidelis Essential Plan QHP	$3,528.25
Rate for Payer: Fidelis Medicare Advantage	$3,964.33
Rate for Payer: Fidelis Qualified Health Plan	$3,528.25
Rate for Payer: Group Health Inc Commercial	$3,964.33
Rate for Payer: Group Health Inc Medicare	$3,964.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,964.33
Rate for Payer: Hamaspik Choice Inc Medicare	$1,579.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$606.24
Rate for Payer: Healthfirst Medicare Advantage	$3,369.68
Rate for Payer: Healthfirst QHP	$3,964.33
Rate for Payer: Humana Medicare	$4,043.62
Rate for Payer: Senior Whole Health Medicare Advantage	$3,964.33
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,964.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,964.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,766.11
Rate for Payer: Wellcare Medicare	$3,766.11

HC OPEN TX, FINGER FRAC W/MANIP

Facility

$653.00

Service Code	CPT 26755
Hospital Charge Code	3612675501
Hospital Revenue Code	361
Min. Negotiated Rate	$128.93
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$293.09
Rate for Payer: Aetna Government	$293.09
Rate for Payer: Affinity Essential Plan 1&2	$205.16
Rate for Payer: Affinity Essential Plan 3&4	$205.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$205.16
Rate for Payer: Brighton Health Commercial	$489.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$293.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$293.09
Rate for Payer: EmblemHealth Commercial	$293.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$263.78
Rate for Payer: Fidelis Essential Plan Aliesa	$249.13
Rate for Payer: Fidelis Essential Plan QHP	$260.85
Rate for Payer: Fidelis Medicare Advantage	$293.09
Rate for Payer: Fidelis Qualified Health Plan	$260.85
Rate for Payer: Group Health Inc Commercial	$293.09
Rate for Payer: Group Health Inc Medicare	$293.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$293.09
Rate for Payer: Hamaspik Choice Inc Medicare	$128.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$339.48
Rate for Payer: Healthfirst Medicare Advantage	$249.13
Rate for Payer: Healthfirst QHP	$293.09
Rate for Payer: Humana Medicare	$298.95
Rate for Payer: Senior Whole Health Medicare Advantage	$293.09
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$293.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$278.44
Rate for Payer: Wellcare Medicare	$278.44

Know your out-of-pocket cost for care.

All Charges