St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC OR LEVEL 1 - 15 MINUTES

Facility

$562.00

Hospital Charge Code	3600000001
Hospital Revenue Code	360
Min. Negotiated Rate	$196.70
Max. Negotiated Rate	$449.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$281.00
Rate for Payer: Aetna Government	$281.00
Rate for Payer: Brighton Health Commercial	$421.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.16
Rate for Payer: EmblemHealth Commercial	$281.00
Rate for Payer: Group Health Inc Commercial	$281.00
Rate for Payer: Group Health Inc Medicare	$196.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.00
Rate for Payer: Hamaspik Choice Inc Medicare	$281.00

HC OR LEVEL 2 - 15 MINUTES

Facility

$687.00

Hospital Charge Code	3600000002
Hospital Revenue Code	360
Min. Negotiated Rate	$240.45
Max. Negotiated Rate	$549.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$377.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$343.50
Rate for Payer: Aetna Government	$343.50
Rate for Payer: Brighton Health Commercial	$515.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$549.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$467.16
Rate for Payer: EmblemHealth Commercial	$343.50
Rate for Payer: Group Health Inc Commercial	$343.50
Rate for Payer: Group Health Inc Medicare	$240.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$343.50
Rate for Payer: Hamaspik Choice Inc Medicare	$343.50

HC OR LEVEL 2 - 15 MINUTES

Facility

$687.00

Hospital Charge Code	3600000002
Hospital Revenue Code	360
Min. Negotiated Rate	$343.50
Max. Negotiated Rate	$343.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$343.50

HC OR LEVEL 3 - 15 MINUTES

Facility

$812.00

Hospital Charge Code	3600000003
Hospital Revenue Code	360
Min. Negotiated Rate	$406.00
Max. Negotiated Rate	$406.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00

HC OR LEVEL 3 - 15 MINUTES

Facility

$812.00

Hospital Charge Code	3600000003
Hospital Revenue Code	360
Min. Negotiated Rate	$284.20
Max. Negotiated Rate	$649.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$406.00
Rate for Payer: Aetna Government	$406.00
Rate for Payer: Brighton Health Commercial	$609.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$649.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.16
Rate for Payer: EmblemHealth Commercial	$406.00
Rate for Payer: Group Health Inc Commercial	$406.00
Rate for Payer: Group Health Inc Medicare	$284.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.00
Rate for Payer: Hamaspik Choice Inc Medicare	$406.00

HC OR LEVEL 4 - 15 MINUTES

Facility

$1,125.00

Hospital Charge Code	3600000009
Hospital Revenue Code	360
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50

HC OR LEVEL 4 - 15 MINUTES

Facility

$1,125.00

Hospital Charge Code	3600000009
Hospital Revenue Code	360
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$900.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$562.50
Rate for Payer: Aetna Government	$562.50
Rate for Payer: Brighton Health Commercial	$843.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$765.00
Rate for Payer: EmblemHealth Commercial	$562.50
Rate for Payer: Group Health Inc Commercial	$562.50
Rate for Payer: Group Health Inc Medicare	$393.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50

HC OR LEVEL 5 - 15 MINUTES

Facility

$1,625.00

Hospital Charge Code	3600000010
Hospital Revenue Code	360
Min. Negotiated Rate	$812.50
Max. Negotiated Rate	$812.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.50

HC OR LEVEL 5 - 15 MINUTES

Facility

$1,625.00

Hospital Charge Code	3600000010
Hospital Revenue Code	360
Min. Negotiated Rate	$568.75
Max. Negotiated Rate	$1,300.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$893.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$812.50
Rate for Payer: Aetna Government	$812.50
Rate for Payer: Brighton Health Commercial	$1,218.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,105.00
Rate for Payer: EmblemHealth Commercial	$812.50
Rate for Payer: Group Health Inc Commercial	$812.50
Rate for Payer: Group Health Inc Medicare	$568.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$812.50

HC OR PROC CANCELED POST-ANES

Facility

$1,500.00

Hospital Charge Code	3600000018
Hospital Revenue Code	360
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00

HC OR PROC CANCELED POST-ANES

Facility

$1,500.00

Hospital Charge Code	3600000018
Hospital Revenue Code	360
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$750.00
Rate for Payer: Aetna Government	$750.00
Rate for Payer: Brighton Health Commercial	$1,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,020.00
Rate for Payer: EmblemHealth Commercial	$750.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

HC OR PROC CANCELED PRE-ANES

Facility

$750.00

Hospital Charge Code	3600000017
Hospital Revenue Code	360
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00

HC OR PROC CANCELED PRE-ANES

Facility

$750.00

Hospital Charge Code	3600000017
Hospital Revenue Code	360
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$600.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$375.00
Rate for Payer: Aetna Government	$375.00
Rate for Payer: Brighton Health Commercial	$562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$510.00
Rate for Payer: EmblemHealth Commercial	$375.00
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

HC ORTHOPOXVIRUS AMP PRB EACH

Facility

$192.00

Service Code	CPT 87593
Hospital Charge Code	3068759301
Hospital Revenue Code	306
Min. Negotiated Rate	$35.92
Max. Negotiated Rate	$153.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.31
Rate for Payer: Aetna Government	$51.31
Rate for Payer: Affinity Essential Plan 1&2	$35.92
Rate for Payer: Affinity Essential Plan 3&4	$35.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$35.92
Rate for Payer: Brighton Health Commercial	$144.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$51.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.56
Rate for Payer: Elderplan Medicare Advantage	$51.31
Rate for Payer: EmblemHealth Commercial	$51.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46.18
Rate for Payer: Fidelis Essential Plan Aliesa	$43.61
Rate for Payer: Fidelis Essential Plan QHP	$45.67
Rate for Payer: Fidelis Medicare Advantage	$51.31
Rate for Payer: Fidelis Qualified Health Plan	$45.67
Rate for Payer: Group Health Inc Commercial	$51.31
Rate for Payer: Group Health Inc Medicare	$51.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.31
Rate for Payer: Hamaspik Choice Inc Medicare	$51.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51.82
Rate for Payer: Healthfirst Essential Plan	$116.59
Rate for Payer: Healthfirst Medicare Advantage	$51.31
Rate for Payer: Healthfirst QHP	$51.31
Rate for Payer: Humana Medicare	$52.34
Rate for Payer: Senior Whole Health Medicare Advantage	$51.31
Rate for Payer: United Healthcare Commercial	$46.05
Rate for Payer: United Healthcare Medicare Advantage	$51.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$51.82
Rate for Payer: Wellcare Medicare	$46.18

HC ORTHOPOXVIRUS AMP PRB EACH

Facility

$192.00

Service Code	CPT 87593
Hospital Charge Code	3068759301
Hospital Revenue Code	306
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$96.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.00

HC OSTEOPATHIC MANIP,1-2 BODY REGN

Facility

$74.00

Service Code	CPT 98925
Hospital Charge Code	5309892501
Hospital Revenue Code	530
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.00

HC OSTEOPATHIC MANIP,1-2 BODY REGN

Facility

$74.00

Service Code	CPT 98925
Hospital Charge Code	5309892501
Hospital Revenue Code	530
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$59.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.91
Rate for Payer: Aetna Government	$30.91
Rate for Payer: Affinity Essential Plan 1&2	$21.64
Rate for Payer: Affinity Essential Plan 3&4	$21.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.64
Rate for Payer: Brighton Health Commercial	$55.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.32
Rate for Payer: Elderplan Medicare Advantage	$30.91
Rate for Payer: EmblemHealth Commercial	$30.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.82
Rate for Payer: Fidelis Essential Plan Aliesa	$26.27
Rate for Payer: Fidelis Essential Plan QHP	$27.51
Rate for Payer: Fidelis Medicare Advantage	$30.91
Rate for Payer: Fidelis Qualified Health Plan	$27.51
Rate for Payer: Group Health Inc Commercial	$30.91
Rate for Payer: Group Health Inc Medicare	$30.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.91
Rate for Payer: Hamaspik Choice Inc Medicare	$30.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.08
Rate for Payer: Healthfirst Medicare Advantage	$26.27
Rate for Payer: Healthfirst QHP	$30.91
Rate for Payer: Humana Medicare	$31.53
Rate for Payer: Senior Whole Health Medicare Advantage	$30.91
Rate for Payer: United Healthcare Medicare Advantage	$30.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.36
Rate for Payer: Wellcare Medicare	$29.36

HC OSTEOPATHIC MANIP,3-4 BODY REGN

Facility

$113.00

Service Code	CPT 98926
Hospital Charge Code	5309892601
Hospital Revenue Code	530
Min. Negotiated Rate	$56.50
Max. Negotiated Rate	$56.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.50

HC OSTEOPATHIC MANIP,3-4 BODY REGN

Facility

$113.00

Service Code	CPT 98926
Hospital Charge Code	5309892601
Hospital Revenue Code	530
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$90.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.91
Rate for Payer: Aetna Government	$30.91
Rate for Payer: Affinity Essential Plan 1&2	$21.64
Rate for Payer: Affinity Essential Plan 3&4	$21.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.64
Rate for Payer: Brighton Health Commercial	$84.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$76.84
Rate for Payer: Elderplan Medicare Advantage	$30.91
Rate for Payer: EmblemHealth Commercial	$30.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.82
Rate for Payer: Fidelis Essential Plan Aliesa	$26.27
Rate for Payer: Fidelis Essential Plan QHP	$27.51
Rate for Payer: Fidelis Medicare Advantage	$30.91
Rate for Payer: Fidelis Qualified Health Plan	$27.51
Rate for Payer: Group Health Inc Commercial	$30.91
Rate for Payer: Group Health Inc Medicare	$30.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.91
Rate for Payer: Hamaspik Choice Inc Medicare	$30.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.80
Rate for Payer: Healthfirst Medicare Advantage	$26.27
Rate for Payer: Healthfirst QHP	$30.91
Rate for Payer: Humana Medicare	$31.53
Rate for Payer: Senior Whole Health Medicare Advantage	$30.91
Rate for Payer: United Healthcare Medicare Advantage	$30.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.36
Rate for Payer: Wellcare Medicare	$29.36

HC OSTEOPATHIC MANIP,5-6 BODY REGN

Facility

$140.00

Service Code	CPT 98927
Hospital Charge Code	5309892701
Hospital Revenue Code	530
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$112.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.91
Rate for Payer: Aetna Government	$30.91
Rate for Payer: Affinity Essential Plan 1&2	$21.64
Rate for Payer: Affinity Essential Plan 3&4	$21.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.64
Rate for Payer: Brighton Health Commercial	$105.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.20
Rate for Payer: Elderplan Medicare Advantage	$30.91
Rate for Payer: EmblemHealth Commercial	$30.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.82
Rate for Payer: Fidelis Essential Plan Aliesa	$26.27
Rate for Payer: Fidelis Essential Plan QHP	$27.51
Rate for Payer: Fidelis Medicare Advantage	$30.91
Rate for Payer: Fidelis Qualified Health Plan	$27.51
Rate for Payer: Group Health Inc Commercial	$30.91
Rate for Payer: Group Health Inc Medicare	$30.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.91
Rate for Payer: Hamaspik Choice Inc Medicare	$30.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.14
Rate for Payer: Healthfirst Medicare Advantage	$26.27
Rate for Payer: Healthfirst QHP	$30.91
Rate for Payer: Humana Medicare	$31.53
Rate for Payer: Senior Whole Health Medicare Advantage	$30.91
Rate for Payer: United Healthcare Medicare Advantage	$30.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.36
Rate for Payer: Wellcare Medicare	$29.36

HC OSTEOPATHIC MANIP,5-6 BODY REGN

Facility

$140.00

Service Code	CPT 98927
Hospital Charge Code	5309892701
Hospital Revenue Code	530
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00

HC OSTEOPATHIC MANIP,7-8 BODY REGN

Facility

$164.00

Service Code	CPT 98928
Hospital Charge Code	5309892801
Hospital Revenue Code	530
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$131.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.91
Rate for Payer: Aetna Government	$30.91
Rate for Payer: Affinity Essential Plan 1&2	$21.64
Rate for Payer: Affinity Essential Plan 3&4	$21.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.64
Rate for Payer: Brighton Health Commercial	$123.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$131.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$111.52
Rate for Payer: Elderplan Medicare Advantage	$30.91
Rate for Payer: EmblemHealth Commercial	$30.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.82
Rate for Payer: Fidelis Essential Plan Aliesa	$26.27
Rate for Payer: Fidelis Essential Plan QHP	$27.51
Rate for Payer: Fidelis Medicare Advantage	$30.91
Rate for Payer: Fidelis Qualified Health Plan	$27.51
Rate for Payer: Group Health Inc Commercial	$30.91
Rate for Payer: Group Health Inc Medicare	$30.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.91
Rate for Payer: Hamaspik Choice Inc Medicare	$30.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63.25
Rate for Payer: Healthfirst Medicare Advantage	$26.27
Rate for Payer: Healthfirst QHP	$30.91
Rate for Payer: Humana Medicare	$31.53
Rate for Payer: Senior Whole Health Medicare Advantage	$30.91
Rate for Payer: United Healthcare Medicare Advantage	$30.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.36
Rate for Payer: Wellcare Medicare	$29.36

HC OSTEOPATHIC MANIP,7-8 BODY REGN

Facility

$164.00

Service Code	CPT 98928
Hospital Charge Code	5309892801
Hospital Revenue Code	530
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00

HC OSTEOPATHIC MANIP,9-10 BODY REGN

Facility

$189.00

Service Code	CPT 98929
Hospital Charge Code	5309892901
Hospital Revenue Code	530
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$151.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.91
Rate for Payer: Aetna Government	$30.91
Rate for Payer: Affinity Essential Plan 1&2	$21.64
Rate for Payer: Affinity Essential Plan 3&4	$21.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$21.64
Rate for Payer: Brighton Health Commercial	$141.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$30.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$151.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.52
Rate for Payer: Elderplan Medicare Advantage	$30.91
Rate for Payer: EmblemHealth Commercial	$30.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27.82
Rate for Payer: Fidelis Essential Plan Aliesa	$26.27
Rate for Payer: Fidelis Essential Plan QHP	$27.51
Rate for Payer: Fidelis Medicare Advantage	$30.91
Rate for Payer: Fidelis Qualified Health Plan	$27.51
Rate for Payer: Group Health Inc Commercial	$30.91
Rate for Payer: Group Health Inc Medicare	$30.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.91
Rate for Payer: Hamaspik Choice Inc Medicare	$30.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$75.19
Rate for Payer: Healthfirst Medicare Advantage	$26.27
Rate for Payer: Healthfirst QHP	$30.91
Rate for Payer: Humana Medicare	$31.53
Rate for Payer: Senior Whole Health Medicare Advantage	$30.91
Rate for Payer: United Healthcare Medicare Advantage	$30.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.36
Rate for Payer: Wellcare Medicare	$29.36

HC OSTEOPATHIC MANIP,9-10 BODY REGN

Facility

$189.00

Service Code	CPT 98929
Hospital Charge Code	5309892901
Hospital Revenue Code	530
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$94.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.50

Know your out-of-pocket cost for care.

All Charges