St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC US,PREGNANT UTERUS,LIMITED, 1/> FETUSES

Facility

$339.00

Service Code	CPT 76815 TC
Hospital Charge Code	4027681502
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US,PREGNANT UTERUS,TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76817 TC
Hospital Charge Code	4027681702
Hospital Revenue Code	402
Min. Negotiated Rate	$46.72
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.72
Rate for Payer: Aetna Government	$46.72
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: EmblemHealth Commercial	$59.25
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.25
Rate for Payer: Healthfirst Essential Plan	$231.50
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$102.89

HC US,PREGNANT UTERUS,TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76817 TC
Hospital Charge Code	4027681703
Hospital Revenue Code	402
Min. Negotiated Rate	$46.72
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.72
Rate for Payer: Aetna Government	$46.72
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$112.12
Rate for Payer: EmblemHealth Commercial	$59.25
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.25
Rate for Payer: Healthfirst Essential Plan	$231.50
Rate for Payer: United Healthcare Commercial	$49.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$102.89

HC US,PREGNANT UTERUS,TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76817 TC
Hospital Charge Code	4027681702
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US,PREGNANT UTERUS,TRANSVAGINAL

Facility

$339.00

Service Code	CPT 76817 TC
Hospital Charge Code	4027681703
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE

Facility

$339.00

Service Code	CPT 76770 TC
Hospital Charge Code	4027677001
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RENAL COMPLETE

Facility

$339.00

Service Code	CPT 76770 TC
Hospital Charge Code	4027677001
Hospital Revenue Code	402
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.39
Rate for Payer: Aetna Government	$60.39
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$76.92
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.92
Rate for Payer: Healthfirst Essential Plan	$231.41
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$102.85

HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RETROPERITONEUM

Facility

$339.00

Service Code	CPT 76770 TC
Hospital Charge Code	4027677002
Hospital Revenue Code	402
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.39
Rate for Payer: Aetna Government	$60.39
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$76.92
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76.92
Rate for Payer: Healthfirst Essential Plan	$231.41
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$102.85

HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE - US RETROPERITONEUM

Facility

$339.00

Service Code	CPT 76770 TC
Hospital Charge Code	4027677002
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US, RETROPERITNL ABD, LTD - US RETROPERITONEUM LIMITED

Facility

$339.00

Service Code	CPT 76775 TC
Hospital Charge Code	4027677502
Hospital Revenue Code	402
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.02
Rate for Payer: Aetna Government	$23.02
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$35.15
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.15
Rate for Payer: Healthfirst Essential Plan	$162.31
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72.14

HC US, RETROPERITNL ABD, LTD - US RETROPERITONEUM LIMITED

Facility

$339.00

Service Code	CPT 76775 TC
Hospital Charge Code	4027677502
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US, RETROPERITNL ABD, LTD - US URINARY BLADDER LIMITED

Facility

$339.00

Service Code	CPT 76775 TC
Hospital Charge Code	4027677501
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC US, RETROPERITNL ABD, LTD - US URINARY BLADDER LIMITED

Facility

$339.00

Service Code	CPT 76775 TC
Hospital Charge Code	4027677501
Hospital Revenue Code	402
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.02
Rate for Payer: Aetna Government	$23.02
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$35.15
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.15
Rate for Payer: Healthfirst Essential Plan	$162.31
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72.14

HC US, SPINAL CANAL & CONTENTS - US SPINAL CANAL AND CONTENTS

Facility

$339.00

Service Code	CPT 76800 TC
Hospital Charge Code	4027680001
Hospital Revenue Code	402
Min. Negotiated Rate	$63.74
Max. Negotiated Rate	$254.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.74
Rate for Payer: Aetna Government	$63.74
Rate for Payer: Brighton Health Commercial	$254.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.43
Rate for Payer: EmblemHealth Commercial	$123.88
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$118.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$123.88
Rate for Payer: Healthfirst Essential Plan	$192.53
Rate for Payer: United Healthcare Commercial	$77.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$85.57

HC US, SPINAL CANAL & CONTENTS - US SPINAL CANAL AND CONTENTS

Facility

$339.00

Service Code	CPT 76800 TC
Hospital Charge Code	4027680001
Hospital Revenue Code	402
Min. Negotiated Rate	$169.50
Max. Negotiated Rate	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.50

HC UVULECTOMY

Facility

$7,933.00

Service Code	CPT 42140
Hospital Charge Code	5104214001
Hospital Revenue Code	510
Min. Negotiated Rate	$3,966.50
Max. Negotiated Rate	$3,966.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,966.50

HC UVULECTOMY

Facility

$7,933.00

Service Code	CPT 42140
Hospital Charge Code	5104214001
Hospital Revenue Code	510
Min. Negotiated Rate	$184.48
Max. Negotiated Rate	$4,160.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,962.45
Rate for Payer: Aetna Government	$3,962.45
Rate for Payer: Affinity Essential Plan 1&2	$2,773.72
Rate for Payer: Affinity Essential Plan 3&4	$2,773.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,773.72
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,962.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$3,962.45
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,566.20
Rate for Payer: Fidelis Essential Plan Aliesa	$3,368.08
Rate for Payer: Fidelis Essential Plan QHP	$3,526.58
Rate for Payer: Fidelis Medicare Advantage	$3,962.45
Rate for Payer: Fidelis Qualified Health Plan	$3,526.58
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	$3,962.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1,394.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.40
Rate for Payer: Healthfirst Medicare Advantage	$3,368.08
Rate for Payer: Healthfirst QHP	$3,962.45
Rate for Payer: Humana Medicare	$4,041.70
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4,160.57
Rate for Payer: Senior Whole Health Medicare Advantage	$3,962.45
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$3,962.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,764.33
Rate for Payer: Wellcare Medicare	$3,764.33

HC VAG DELIV ONLY,PREV C-SECTN

Facility

$8,480.00

Service Code	CPT 59612
Hospital Charge Code	5105961202
Hospital Revenue Code	510
Min. Negotiated Rate	$184.48
Max. Negotiated Rate	$4,079.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,884.81
Rate for Payer: Aetna Government	$3,884.81
Rate for Payer: Affinity Essential Plan 1&2	$2,719.37
Rate for Payer: Affinity Essential Plan 3&4	$2,719.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,719.37
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,884.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$217.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$184.48
Rate for Payer: Elderplan Medicare Advantage	$3,884.81
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,496.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,302.09
Rate for Payer: Fidelis Essential Plan QHP	$3,457.48
Rate for Payer: Fidelis Medicare Advantage	$3,884.81
Rate for Payer: Fidelis Qualified Health Plan	$3,457.48
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	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,097.60
Rate for Payer: Healthfirst Medicare Advantage	$3,302.09
Rate for Payer: Healthfirst QHP	$3,884.81
Rate for Payer: Humana Medicare	$3,962.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4,079.05
Rate for Payer: Senior Whole Health Medicare Advantage	$3,884.81
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$3,884.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,884.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,690.57
Rate for Payer: Wellcare Medicare	$3,690.57

HC VAG DELIV ONLY,PREV C-SECTN

Facility

$8,480.00

Service Code	CPT 59612
Hospital Charge Code	5105961202
Hospital Revenue Code	510
Min. Negotiated Rate	$4,240.00
Max. Negotiated Rate	$4,240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,240.00

HC VAGINAL DELIVERY ONLY

Facility

$7,566.00

Service Code	CPT 59409
Hospital Charge Code	4505940901
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$4,079.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,884.81
Rate for Payer: Aetna Government	$3,884.81
Rate for Payer: Affinity Essential Plan 1&2	$2,719.37
Rate for Payer: Affinity Essential Plan 3&4	$2,719.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,719.37
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$3,884.81
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$3,884.81
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,884.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$792.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$673.89
Rate for Payer: Elderplan Medicare Advantage	$3,884.81
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,496.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,302.09
Rate for Payer: Fidelis Essential Plan QHP	$3,457.48
Rate for Payer: Fidelis Medicare Advantage	$3,884.81
Rate for Payer: Fidelis Qualified Health Plan	$3,457.48
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$3,884.81
Rate for Payer: Humana Medicare	$3,962.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$4,079.05
Rate for Payer: Senior Whole Health Medicare Advantage	$3,884.81
Rate for Payer: United Healthcare Commercial	$569.00
Rate for Payer: United Healthcare Medicare Advantage	$3,884.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,884.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,690.57
Rate for Payer: Wellcare Medicare	$3,690.57

HC VAGINAL DELIVERY ONLY

Facility

$7,566.00

Service Code	CPT 59409
Hospital Charge Code	4505940901
Hospital Revenue Code	450
Min. Negotiated Rate	$3,783.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.00

HC VAGINAL DELIVERY ONLY - LEVEL ONE

Facility

$9,895.00

Service Code	CPT 59409
Hospital Charge Code	7225940901
Hospital Revenue Code	722
Min. Negotiated Rate	$957.21
Max. Negotiated Rate	$8,223.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,884.81
Rate for Payer: Aetna Government	$3,884.81
Rate for Payer: Affinity Essential Plan 1&2	$2,719.37
Rate for Payer: Affinity Essential Plan 3&4	$2,719.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,719.37
Rate for Payer: Brighton Health Commercial	$7,421.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,884.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,916.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,728.60
Rate for Payer: Elderplan Medicare Advantage	$3,884.81
Rate for Payer: EmblemHealth Commercial	$3,884.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,496.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,302.09
Rate for Payer: Fidelis Essential Plan QHP	$3,457.48
Rate for Payer: Fidelis Medicare Advantage	$3,884.81
Rate for Payer: Fidelis Qualified Health Plan	$3,457.48
Rate for Payer: Group Health Inc Commercial	$3,884.81
Rate for Payer: Group Health Inc Medicare	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$957.21
Rate for Payer: Healthfirst Medicare Advantage	$3,302.09
Rate for Payer: Healthfirst QHP	$3,884.81
Rate for Payer: Humana Medicare	$3,962.51
Rate for Payer: Senior Whole Health Medicare Advantage	$3,884.81
Rate for Payer: United Healthcare Commercial	$8,223.00
Rate for Payer: United Healthcare Medicare Advantage	$3,884.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,884.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,690.57
Rate for Payer: Wellcare Medicare	$3,690.57

HC VAGINAL DELIVERY ONLY - LEVEL ONE

Facility

$9,895.00

Service Code	CPT 59409
Hospital Charge Code	7225940901
Hospital Revenue Code	722
Min. Negotiated Rate	$4,947.50
Max. Negotiated Rate	$4,947.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,947.50

HC VAGINAL DELIVERY ONLY - LEVEL TWO

Facility

$9,895.00

Service Code	CPT 59409
Hospital Charge Code	7225940902
Hospital Revenue Code	722
Min. Negotiated Rate	$957.21
Max. Negotiated Rate	$8,223.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,884.81
Rate for Payer: Aetna Government	$3,884.81
Rate for Payer: Affinity Essential Plan 1&2	$2,719.37
Rate for Payer: Affinity Essential Plan 3&4	$2,719.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,719.37
Rate for Payer: Brighton Health Commercial	$7,421.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,884.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,916.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,728.60
Rate for Payer: Elderplan Medicare Advantage	$3,884.81
Rate for Payer: EmblemHealth Commercial	$3,884.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,496.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,302.09
Rate for Payer: Fidelis Essential Plan QHP	$3,457.48
Rate for Payer: Fidelis Medicare Advantage	$3,884.81
Rate for Payer: Fidelis Qualified Health Plan	$3,457.48
Rate for Payer: Group Health Inc Commercial	$3,884.81
Rate for Payer: Group Health Inc Medicare	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,884.81
Rate for Payer: Hamaspik Choice Inc Medicare	$3,884.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$957.21
Rate for Payer: Healthfirst Medicare Advantage	$3,302.09
Rate for Payer: Healthfirst QHP	$3,884.81
Rate for Payer: Humana Medicare	$3,962.51
Rate for Payer: Senior Whole Health Medicare Advantage	$3,884.81
Rate for Payer: United Healthcare Commercial	$8,223.00
Rate for Payer: United Healthcare Medicare Advantage	$3,884.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,884.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,690.57
Rate for Payer: Wellcare Medicare	$3,690.57

HC VAGINAL DELIVERY ONLY - LEVEL TWO

Facility

$9,895.00

Service Code	CPT 59409
Hospital Charge Code	7225940902
Hospital Revenue Code	722
Min. Negotiated Rate	$4,947.50
Max. Negotiated Rate	$4,947.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,947.50

Know your out-of-pocket cost for care.

All Charges