St. Barnabas Hospital

All Charges

Charge

Type

Price

EQ DILATION OF NEPHROSTOM

Facility OP

$5,365.58

Service Code	HCPCS 74485 TC
Hospital Charge Code	41102532
Hospital Revenue Code	320
Min. Negotiated Rate	$89.78
Max. Negotiated Rate	$4,292.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,951.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,682.79
Rate for Payer: Aetna Government	$2,682.79
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cash Price	$2,355.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,292.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,648.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$89.78
Rate for Payer: Group Health Inc Commercial	$2,682.79
Rate for Payer: Group Health Inc Medicare	$1,877.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,682.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2,682.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$99.76

EQ EACH ADD. VESSEL

Facility OP

$2,729.16

Service Code	HCPCS 75774 TC
Hospital Charge Code	41102594
Hospital Revenue Code	320
Min. Negotiated Rate	$57.26
Max. Negotiated Rate	$2,183.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,501.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,364.58
Rate for Payer: Aetna Government	$1,364.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,183.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,855.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$57.26
Rate for Payer: Group Health Inc Commercial	$1,364.58
Rate for Payer: Group Health Inc Medicare	$955.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,364.58
Rate for Payer: Hamaspik Choice Inc Medicare	$1,364.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63.62

EQ ELBOW ARTHROGRAM

Facility OP

$1,156.53

Service Code	HCPCS 73085 TC
Hospital Charge Code	41102462
Hospital Revenue Code	320
Min. Negotiated Rate	$94.59
Max. Negotiated Rate	$925.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$636.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$578.26
Rate for Payer: Aetna Government	$578.26
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$925.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$786.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$94.59
Rate for Payer: Group Health Inc Commercial	$578.26
Rate for Payer: Group Health Inc Medicare	$404.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.26
Rate for Payer: Hamaspik Choice Inc Medicare	$578.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$105.10

EQ EMBOLIZ. (EXTRACRANIAL)

Facility OP

$3,200.13

Service Code	HCPCS 75894 TC
Hospital Charge Code	41102746
Hospital Revenue Code	320
Min. Negotiated Rate	$1,120.05
Max. Negotiated Rate	$2,560.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,600.06
Rate for Payer: Aetna Government	$1,600.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,560.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,176.09
Rate for Payer: Group Health Inc Commercial	$1,600.06
Rate for Payer: Group Health Inc Medicare	$1,120.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.06

EQ EMBOLIZ. (INTRA/S. CORD)

Facility OP

$3,200.13

Service Code	HCPCS 75894 TC
Hospital Charge Code	41102744
Hospital Revenue Code	320
Min. Negotiated Rate	$1,120.05
Max. Negotiated Rate	$2,560.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,600.06
Rate for Payer: Aetna Government	$1,600.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,560.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,176.09
Rate for Payer: Group Health Inc Commercial	$1,600.06
Rate for Payer: Group Health Inc Medicare	$1,120.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.06

EQ EMBOLIZ. (NON-NEURO)

Facility OP

$3,200.13

Service Code	HCPCS 75894 TC
Hospital Charge Code	41102742
Hospital Revenue Code	320
Min. Negotiated Rate	$1,120.05
Max. Negotiated Rate	$2,560.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,600.06
Rate for Payer: Aetna Government	$1,600.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,560.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,176.09
Rate for Payer: Group Health Inc Commercial	$1,600.06
Rate for Payer: Group Health Inc Medicare	$1,120.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.06

EQ EMBO VARIX

Facility OP

$3,200.13

Service Code	HCPCS 75894 TC
Hospital Charge Code	41107731
Hospital Revenue Code	320
Min. Negotiated Rate	$1,120.05
Max. Negotiated Rate	$2,560.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,600.06
Rate for Payer: Aetna Government	$1,600.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,560.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,176.09
Rate for Payer: Group Health Inc Commercial	$1,600.06
Rate for Payer: Group Health Inc Medicare	$1,120.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.06

EQ ENTIRE SPINE MYELOGRAM

Facility OP

$2,062.03

Service Code	HCPCS 72270 TC
Hospital Charge Code	41102454
Hospital Revenue Code	320
Min. Negotiated Rate	$110.48
Max. Negotiated Rate	$1,649.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,031.02
Rate for Payer: Aetna Government	$1,031.02
Rate for Payer: Cash Price	$925.92
Rate for Payer: Cash Price	$925.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,649.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,402.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$110.48
Rate for Payer: Group Health Inc Commercial	$1,031.02
Rate for Payer: Group Health Inc Medicare	$721.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$122.76

EQ EPIDURAL

Facility OP

$1,909.65

Service Code	HCPCS 75872 TC
Hospital Charge Code	41102697
Hospital Revenue Code	320
Min. Negotiated Rate	$84.20
Max. Negotiated Rate	$1,527.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,050.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$954.82
Rate for Payer: Aetna Government	$954.82
Rate for Payer: Cash Price	$726.47
Rate for Payer: Cash Price	$726.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,527.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,298.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$84.20
Rate for Payer: Group Health Inc Commercial	$954.82
Rate for Payer: Group Health Inc Medicare	$668.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$954.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$93.56

EQ E.R.C.P.

Facility OP

$697.79

Service Code	HCPCS 74330 TC
Hospital Charge Code	41102012
Hospital Revenue Code	320
Min. Negotiated Rate	$244.23
Max. Negotiated Rate	$558.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$383.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$348.90
Rate for Payer: Aetna Government	$348.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$558.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$474.50
Rate for Payer: Group Health Inc Commercial	$348.90
Rate for Payer: Group Health Inc Medicare	$244.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$348.90
Rate for Payer: Hamaspik Choice Inc Medicare	$348.90

EQ EXTREM ART BILATERAL

Facility OP

$8,393.53

Service Code	HCPCS 75716 TC
Hospital Charge Code	41102675
Hospital Revenue Code	320
Min. Negotiated Rate	$80.14
Max. Negotiated Rate	$6,714.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,196.76
Rate for Payer: Aetna Government	$4,196.76
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,714.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,707.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.14
Rate for Payer: Group Health Inc Commercial	$4,196.76
Rate for Payer: Group Health Inc Medicare	$2,937.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$89.05

EQ EXTREM ART UNILATERAL

Facility OP

$8,393.53

Service Code	HCPCS 75710 TC
Hospital Charge Code	41102677
Hospital Revenue Code	320
Min. Negotiated Rate	$77.18
Max. Negotiated Rate	$6,714.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,196.76
Rate for Payer: Aetna Government	$4,196.76
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,714.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,707.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$77.18
Rate for Payer: Group Health Inc Commercial	$4,196.76
Rate for Payer: Group Health Inc Medicare	$2,937.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$85.76

EQ EXTREMITY ANGIO - UNI LIM

Facility OP

$8,393.53

Service Code	HCPCS 75710 TC
Hospital Charge Code	41109574
Hospital Revenue Code	320
Min. Negotiated Rate	$77.18
Max. Negotiated Rate	$6,714.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,616.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,196.76
Rate for Payer: Aetna Government	$4,196.76
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cash Price	$3,686.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,714.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,707.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$77.18
Rate for Payer: Group Health Inc Commercial	$4,196.76
Rate for Payer: Group Health Inc Medicare	$2,937.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,196.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,196.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$85.76

EQ EXTREM. VEN. BI

Facility OP

$4,940.28

Service Code	HCPCS 75822 TC
Hospital Charge Code	41102596
Hospital Revenue Code	320
Min. Negotiated Rate	$72.78
Max. Negotiated Rate	$3,952.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,717.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,470.14
Rate for Payer: Aetna Government	$2,470.14
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,952.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,359.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$72.78
Rate for Payer: Group Health Inc Commercial	$2,470.14
Rate for Payer: Group Health Inc Medicare	$1,729.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,470.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2,470.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$80.87

EQ EXTREM. VEN. UNI

Facility OP

$1,909.65

Service Code	HCPCS 75820 TC
Hospital Charge Code	41102054
Hospital Revenue Code	320
Min. Negotiated Rate	$67.24
Max. Negotiated Rate	$1,527.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,050.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$954.82
Rate for Payer: Aetna Government	$954.82
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cash Price	$1,852.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,527.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,298.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67.24
Rate for Payer: Group Health Inc Commercial	$954.82
Rate for Payer: Group Health Inc Medicare	$668.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.82
Rate for Payer: Hamaspik Choice Inc Medicare	$954.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$74.71

EQ FALLOPIAN DILATION

Facility OP

$1,147.78

Service Code	HCPCS 74742 TC
Hospital Charge Code	41108585
Hospital Revenue Code	320
Min. Negotiated Rate	$401.72
Max. Negotiated Rate	$918.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$631.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$573.89
Rate for Payer: Aetna Government	$573.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$918.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$780.49
Rate for Payer: Group Health Inc Commercial	$573.89
Rate for Payer: Group Health Inc Medicare	$401.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$573.89
Rate for Payer: Hamaspik Choice Inc Medicare	$573.89

EQ FISTULA OR SINUS TRACT STUDY

Facility OP

$1,458.58

Service Code	HCPCS 76080 TC
Hospital Charge Code	41107627
Hospital Revenue Code	320
Min. Negotiated Rate	$39.52
Max. Negotiated Rate	$1,166.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$802.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$729.29
Rate for Payer: Aetna Government	$729.29
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39.52
Rate for Payer: Group Health Inc Commercial	$729.29
Rate for Payer: Group Health Inc Medicare	$510.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.29
Rate for Payer: Hamaspik Choice Inc Medicare	$729.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.91

EQ FISTULA/SINUS TRACT

Facility OP

$1,458.58

Service Code	HCPCS 76080 TC
Hospital Charge Code	41102136
Hospital Revenue Code	320
Min. Negotiated Rate	$39.52
Max. Negotiated Rate	$1,166.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$802.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$729.29
Rate for Payer: Aetna Government	$729.29
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cash Price	$637.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,166.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$991.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39.52
Rate for Payer: Group Health Inc Commercial	$729.29
Rate for Payer: Group Health Inc Medicare	$510.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$729.29
Rate for Payer: Hamaspik Choice Inc Medicare	$729.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.91

EQ FL GUID REMV VEN ACC DEV

Facility OP

$329.14

Service Code	HCPCS 77001 TC
Hospital Charge Code	41109856
Hospital Revenue Code	320
Min. Negotiated Rate	$92.38
Max. Negotiated Rate	$263.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$164.57
Rate for Payer: Aetna Government	$164.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$263.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$223.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$92.38
Rate for Payer: Group Health Inc Commercial	$164.57
Rate for Payer: Group Health Inc Medicare	$115.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.57
Rate for Payer: Hamaspik Choice Inc Medicare	$164.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$102.64

EQ FLUORO FOR BIOP/ASP

Facility OP

$1,144.39

Service Code	HCPCS 77002 TC
Hospital Charge Code	41102632
Hospital Revenue Code	320
Min. Negotiated Rate	$100.13
Max. Negotiated Rate	$915.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$572.20
Rate for Payer: Aetna Government	$572.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$778.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$100.13
Rate for Payer: Group Health Inc Commercial	$572.20
Rate for Payer: Group Health Inc Medicare	$400.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.20
Rate for Payer: Hamaspik Choice Inc Medicare	$572.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.26

EQ FLUORO GD VASC ACC

Facility OP

$329.14

Service Code	HCPCS 77001 TC
Hospital Charge Code	41109851
Hospital Revenue Code	320
Min. Negotiated Rate	$92.38
Max. Negotiated Rate	$263.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$164.57
Rate for Payer: Aetna Government	$164.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$263.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$223.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$92.38
Rate for Payer: Group Health Inc Commercial	$164.57
Rate for Payer: Group Health Inc Medicare	$115.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.57
Rate for Payer: Hamaspik Choice Inc Medicare	$164.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$102.64

EQ FLUORO MORE THAN 1 HOUR

Facility OP

$705.83

Service Code	HCPCS 76000 TC
Hospital Charge Code	41102638
Hospital Revenue Code	320
Min. Negotiated Rate	$31.38
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.38
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.87

EQ FLUORO UP TO 1 HOUR

Facility OP

$705.83

Service Code	HCPCS 76000 TC
Hospital Charge Code	41102630
Hospital Revenue Code	320
Min. Negotiated Rate	$31.38
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.38
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34.87

EQ FLURO. GUID INTRTHOR LE

Facility OP

$1,144.39

Service Code	HCPCS 77002 TC
Hospital Charge Code	41102418
Hospital Revenue Code	320
Min. Negotiated Rate	$100.13
Max. Negotiated Rate	$915.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$629.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$572.20
Rate for Payer: Aetna Government	$572.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$778.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$100.13
Rate for Payer: Group Health Inc Commercial	$572.20
Rate for Payer: Group Health Inc Medicare	$400.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$572.20
Rate for Payer: Hamaspik Choice Inc Medicare	$572.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$111.26

EQ GALACTOGRAM

Facility OP

$705.83

Service Code	HCPCS 77053 TC
Hospital Charge Code	41102666
Hospital Revenue Code	320
Min. Negotiated Rate	$40.63
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$352.92
Rate for Payer: Aetna Government	$352.92
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40.63
Rate for Payer: Group Health Inc Commercial	$352.92
Rate for Payer: Group Health Inc Medicare	$247.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$352.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45.14

Price Transparency.

All Charges