St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DTAP-HEPATITIS B RECOMB-IPV IM SUSY [183806]

Facility

$233.62

Service Code	NDC 58160081152
Hospital Charge Code	58160081152
Hospital Revenue Code	250
Min. Negotiated Rate	$81.77
Max. Negotiated Rate	$186.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$128.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$116.81
Rate for Payer: Aetna Government	$116.81
Rate for Payer: Brighton Health Commercial	$175.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.86
Rate for Payer: Group Health Inc Commercial	$116.81
Rate for Payer: Group Health Inc Medicare	$81.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.81
Rate for Payer: Hamaspik Choice Inc Medicare	$116.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$151.85

DTAP-HEP B-IPV

Facility

$208.13

Service Code	HCPCS 90732
Hospital Charge Code	30300167
Hospital Revenue Code	636
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$4,368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$125.92
Rate for Payer: Aetna Government	$125.92
Rate for Payer: Affinity Essential Plan 1&2	$98.28
Rate for Payer: Affinity Essential Plan 3&4	$98.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.68
Rate for Payer: Amida Care Medicaid	$43.68
Rate for Payer: Brighton Health Commercial	$124.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,368.00
Rate for Payer: Fidelis Essential Plan Aliesa	$43.68
Rate for Payer: Fidelis Essential Plan QHP	$43.68
Rate for Payer: Fidelis Qualified Health Plan	$45.86
Rate for Payer: Group Health Inc Commercial	$104.06
Rate for Payer: Group Health Inc Medicare	$72.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.68
Rate for Payer: Hamaspik Choice Inc Medicare	$104.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.68
Rate for Payer: Healthfirst Essential Plan	$98.28
Rate for Payer: Healthfirst QHP	$43.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.68
Rate for Payer: SOMOS Essential	$43.68
Rate for Payer: United Healthcare Commercial	$133.47
Rate for Payer: United Healthcare Essential Plan 1&2	$98.28
Rate for Payer: United Healthcare Essential Plan 3&4	$48.05
Rate for Payer: United Healthcare Medicaid	$43.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.68

DTAP-HEP B-IPV

Facility

$208.13

Service Code	HCPCS 90732
Hospital Charge Code	30300167
Hospital Revenue Code	636
Min. Negotiated Rate	$104.06
Max. Negotiated Rate	$104.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.06
Rate for Payer: Hamaspik Choice Inc Medicare	$104.06

DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSP [176059]

Facility

$351.24

Service Code	NDC 63361024310
Hospital Charge Code	63361024310
Hospital Revenue Code	250
Min. Negotiated Rate	$122.93
Max. Negotiated Rate	$280.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.62
Rate for Payer: Aetna Government	$175.62
Rate for Payer: Brighton Health Commercial	$263.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.84
Rate for Payer: Group Health Inc Commercial	$175.62
Rate for Payer: Group Health Inc Medicare	$122.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.62
Rate for Payer: Hamaspik Choice Inc Medicare	$175.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$228.31

DTAP-IPV-HIB VACCINE IM SUSR [92074]

Facility

$136.68

Service Code	NDC 49281051105
Hospital Charge Code	49281051105
Hospital Revenue Code	250
Min. Negotiated Rate	$47.84
Max. Negotiated Rate	$109.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$75.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.34
Rate for Payer: Aetna Government	$68.34
Rate for Payer: Brighton Health Commercial	$102.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$109.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.94
Rate for Payer: Group Health Inc Commercial	$68.34
Rate for Payer: Group Health Inc Medicare	$47.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.34
Rate for Payer: Hamaspik Choice Inc Medicare	$68.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.84

DTAP--IPV/HIP(PENTACEL)

Facility

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	30301292
Hospital Revenue Code	636
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$51.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50

DTAP--IPV/HIP(PENTACEL)

Facility

$103.00

Service Code	HCPCS 90698
Hospital Charge Code	30301292
Hospital Revenue Code	636
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$105.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$105.11
Rate for Payer: Aetna Government	$105.11
Rate for Payer: Brighton Health Commercial	$61.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.22
Rate for Payer: Group Health Inc Commercial	$51.50
Rate for Payer: Group Health Inc Medicare	$36.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.50
Rate for Payer: Hamaspik Choice Inc Medicare	$51.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.95

DTAP/IPV (KINRIX)

Facility

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	30301293
Hospital Revenue Code	636
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38

DTAP/IPV (KINRIX)

Facility

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	30301293
Hospital Revenue Code	636
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$56.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.24
Rate for Payer: Aetna Government	$56.24
Rate for Payer: Brighton Health Commercial	$41.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$34.38
Rate for Payer: Group Health Inc Medicare	$24.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.69

DTAP IPV VACC 4-6 YR, IM

Facility

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41656805
Hospital Revenue Code	636
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38

DTAP IPV VACC 4-6 YR, IM

Facility

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41646805
Hospital Revenue Code	636
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$34.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38

DTAP IPV VACC 4-6 YR, IM

Facility

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41656805
Hospital Revenue Code	636
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$56.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.24
Rate for Payer: Aetna Government	$56.24
Rate for Payer: Brighton Health Commercial	$41.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$34.38
Rate for Payer: Group Health Inc Medicare	$24.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.69

DTAP IPV VACC 4-6 YR, IM

Facility

$68.76

Service Code	HCPCS 90696
Hospital Charge Code	41646805
Hospital Revenue Code	636
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$56.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$56.24
Rate for Payer: Aetna Government	$56.24
Rate for Payer: Brighton Health Commercial	$41.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.54
Rate for Payer: Group Health Inc Commercial	$34.38
Rate for Payer: Group Health Inc Medicare	$24.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.38
Rate for Payer: Hamaspik Choice Inc Medicare	$34.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.69

DTAP-IPV VACCINE 0.5 ML IM SUSY [180682]

Facility

$145.39

Service Code	NDC 58160081252
Hospital Charge Code	58160081252
Hospital Revenue Code	250
Min. Negotiated Rate	$50.89
Max. Negotiated Rate	$116.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$72.70
Rate for Payer: Aetna Government	$72.70
Rate for Payer: Brighton Health Commercial	$109.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.87
Rate for Payer: Group Health Inc Commercial	$72.70
Rate for Payer: Group Health Inc Medicare	$50.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.70
Rate for Payer: Hamaspik Choice Inc Medicare	$72.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.50

DTAP-IPV VACCINE IM SUSP [92788]

Facility

$148.09

Service Code	NDC 49281056210
Hospital Charge Code	49281056210
Hospital Revenue Code	250
Min. Negotiated Rate	$51.83
Max. Negotiated Rate	$118.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$81.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.05
Rate for Payer: Aetna Government	$74.05
Rate for Payer: Brighton Health Commercial	$111.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$118.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$100.70
Rate for Payer: Group Health Inc Commercial	$74.05
Rate for Payer: Group Health Inc Medicare	$51.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.05
Rate for Payer: Hamaspik Choice Inc Medicare	$74.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$96.26

DUAL CHAMBER PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93288 TC
Hospital Charge Code	30305901
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

DUAL CHAMBER PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93288 TC
Hospital Charge Code	40804102
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

DUAL CHAMBER PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93288 TC
Hospital Charge Code	30305901
Hospital Revenue Code	480
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.61
Rate for Payer: Aetna Government	$43.61
Rate for Payer: Affinity Essential Plan 1&2	$30.53
Rate for Payer: Affinity Essential Plan 3&4	$30.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$30.53
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Elderplan Medicare Advantage	$43.61
Rate for Payer: EmblemHealth Commercial	$43.61
Rate for Payer: Fidelis Essential Plan Aliesa	$37.07
Rate for Payer: Fidelis Essential Plan QHP	$38.81
Rate for Payer: Fidelis Medicare Advantage	$43.61
Rate for Payer: Fidelis Qualified Health Plan	$38.81
Rate for Payer: Group Health Inc Commercial	$43.61
Rate for Payer: Group Health Inc Medicare	$43.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$43.61
Rate for Payer: Healthfirst Medicare Advantage	$37.07
Rate for Payer: Healthfirst QHP	$43.61
Rate for Payer: Humana Medicare	$44.48
Rate for Payer: Senior Whole Health Medicare Advantage	$43.61
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$43.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.89
Rate for Payer: Wellcare Medicare	$41.43

DUAL CHAMBER PCMKR CHECK

Facility

$109.80

Service Code	HCPCS 93288 TC
Hospital Charge Code	40804102
Hospital Revenue Code	480
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.61
Rate for Payer: Aetna Government	$43.61
Rate for Payer: Affinity Essential Plan 1&2	$30.53
Rate for Payer: Affinity Essential Plan 3&4	$30.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$30.53
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Elderplan Medicare Advantage	$43.61
Rate for Payer: EmblemHealth Commercial	$43.61
Rate for Payer: Fidelis Essential Plan Aliesa	$37.07
Rate for Payer: Fidelis Essential Plan QHP	$38.81
Rate for Payer: Fidelis Medicare Advantage	$43.61
Rate for Payer: Fidelis Qualified Health Plan	$38.81
Rate for Payer: Group Health Inc Commercial	$43.61
Rate for Payer: Group Health Inc Medicare	$43.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$43.61
Rate for Payer: Healthfirst Medicare Advantage	$37.07
Rate for Payer: Healthfirst QHP	$43.61
Rate for Payer: Humana Medicare	$44.48
Rate for Payer: Senior Whole Health Medicare Advantage	$43.61
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$43.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.89
Rate for Payer: Wellcare Medicare	$41.43

DUAL CHAMBER RATE RESP PACEMAKER

Facility

$10,600.00

Service Code	HCPCS C1785
Hospital Charge Code	40009102
Hospital Revenue Code	275
Min. Negotiated Rate	$275.42
Max. Negotiated Rate	$11,130.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,830.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.42
Rate for Payer: Aetna Government	$275.42
Rate for Payer: Brighton Health Commercial	$6,360.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,095.00
Rate for Payer: EmblemHealth Commercial	$5,300.00
Rate for Payer: Fidelis Medicare Advantage	$11,130.00
Rate for Payer: Group Health Inc Commercial	$5,300.00
Rate for Payer: Group Health Inc Medicare	$3,710.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,890.00

DUAL LEADES MESH CADHODES

Facility

$23,285.00

Hospital Charge Code	64902999
Hospital Revenue Code	272
Min. Negotiated Rate	$8,149.75
Max. Negotiated Rate	$18,628.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,806.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11,642.50
Rate for Payer: Aetna Government	$11,642.50
Rate for Payer: Brighton Health Commercial	$17,463.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,628.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,833.80
Rate for Payer: Group Health Inc Commercial	$11,642.50
Rate for Payer: Group Health Inc Medicare	$8,149.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,642.50
Rate for Payer: Hamaspik Choice Inc Medicare	$11,642.50

DUAL LEAD ICD W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93283 TC
Hospital Charge Code	30305065
Hospital Revenue Code	480
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.61
Rate for Payer: Aetna Government	$43.61
Rate for Payer: Affinity Essential Plan 1&2	$30.53
Rate for Payer: Affinity Essential Plan 3&4	$30.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$30.53
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Elderplan Medicare Advantage	$43.61
Rate for Payer: EmblemHealth Commercial	$43.61
Rate for Payer: Fidelis Essential Plan Aliesa	$37.07
Rate for Payer: Fidelis Essential Plan QHP	$38.81
Rate for Payer: Fidelis Medicare Advantage	$43.61
Rate for Payer: Fidelis Qualified Health Plan	$38.81
Rate for Payer: Group Health Inc Commercial	$43.61
Rate for Payer: Group Health Inc Medicare	$43.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$43.61
Rate for Payer: Healthfirst Medicare Advantage	$37.07
Rate for Payer: Healthfirst QHP	$43.61
Rate for Payer: Humana Medicare	$44.48
Rate for Payer: Senior Whole Health Medicare Advantage	$43.61
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$43.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.89
Rate for Payer: Wellcare Medicare	$41.43

DUAL LEAD ICD W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93283 TC
Hospital Charge Code	30305065
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

DUAL LEAD PACE W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93280 TC
Hospital Charge Code	30305062
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

DUAL LEAD PACE W/REPROGRAM

Facility

$109.80

Service Code	HCPCS 93280 TC
Hospital Charge Code	30305062
Hospital Revenue Code	480
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.61
Rate for Payer: Aetna Government	$43.61
Rate for Payer: Affinity Essential Plan 1&2	$30.53
Rate for Payer: Affinity Essential Plan 3&4	$30.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$30.53
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Elderplan Medicare Advantage	$43.61
Rate for Payer: EmblemHealth Commercial	$43.61
Rate for Payer: Fidelis Essential Plan Aliesa	$37.07
Rate for Payer: Fidelis Essential Plan QHP	$38.81
Rate for Payer: Fidelis Medicare Advantage	$43.61
Rate for Payer: Fidelis Qualified Health Plan	$38.81
Rate for Payer: Group Health Inc Commercial	$43.61
Rate for Payer: Group Health Inc Medicare	$43.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$43.61
Rate for Payer: Healthfirst Medicare Advantage	$37.07
Rate for Payer: Healthfirst QHP	$43.61
Rate for Payer: Humana Medicare	$44.48
Rate for Payer: Senior Whole Health Medicare Advantage	$43.61
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$43.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.89
Rate for Payer: Wellcare Medicare	$41.43

Know your out-of-pocket cost for care.

All Charges