St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EEG AWAKE AND ASLEEP

Facility

$766.58

Service Code	HCPCS 95819 TC
Hospital Charge Code	30307896
Hospital Revenue Code	740
Rate for Payer: Cash Price	$362.98

EEG AWAKE AND ASLEEP

Facility

$766.58

Service Code	HCPCS 95819 TC
Hospital Charge Code	30307896
Hospital Revenue Code	740
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

EEG CONT REC W/VID EEG TECH

Facility

$766.58

Service Code	HCPCS 95700
Hospital Charge Code	41001008
Hospital Revenue Code	740
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.64
Rate for Payer: Aetna Government	$180.64
Rate for Payer: Affinity Essential Plan 1&2	$126.45
Rate for Payer: Affinity Essential Plan 3&4	$126.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$126.45
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Cash Price	$180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$180.64
Rate for Payer: EmblemHealth Commercial	$180.64
Rate for Payer: Fidelis Essential Plan Aliesa	$153.54
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$180.64
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$180.64
Rate for Payer: Group Health Inc Medicare	$180.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$180.64
Rate for Payer: Healthfirst Medicare Advantage	$153.54
Rate for Payer: Healthfirst QHP	$180.64
Rate for Payer: Humana Medicare	$184.25
Rate for Payer: Senior Whole Health Medicare Advantage	$180.64
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.51
Rate for Payer: Wellcare Medicare	$171.61

EEG CONT REC W/VID EEG TECH

Facility

$766.58

Service Code	HCPCS 95700
Hospital Charge Code	41001008
Hospital Revenue Code	740
Rate for Payer: Cash Price	$180.64

EEG PHY/QHP>36<60 HR W/O VID

Facility

$0.01

Service Code	HCPCS 95721
Hospital Charge Code	41001019
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$183.76
Rate for Payer: Aetna Government	$183.76
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHY/QHP>36<60 HR W/VEEG

Facility

$0.01

Service Code	HCPCS 95722
Hospital Charge Code	41001020
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.63
Rate for Payer: Aetna Government	$223.63
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHY/QHP>60<84 HR W/O VID

Facility

$0.01

Service Code	HCPCS 95723
Hospital Charge Code	41001021
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$228.04
Rate for Payer: Aetna Government	$228.04
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHY/QHP>60<84 HR W/VEEG

Facility

$0.01

Service Code	HCPCS 95724
Hospital Charge Code	41001022
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$284.99
Rate for Payer: Aetna Government	$284.99
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHY/QHP>84 HR W/O VID

Facility

$0.01

Service Code	HCPCS 95725
Hospital Charge Code	41001023
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.46
Rate for Payer: Aetna Government	$259.46
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHY/QHP>84 HR W/VEEG

Facility

$0.01

Service Code	HCPCS 95726
Hospital Charge Code	41001024
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$360.20
Rate for Payer: Aetna Government	$360.20
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHY/QHP EA INCR W/VEEG

Facility

$0.01

Service Code	HCPCS 95720
Hospital Charge Code	41001018
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$183.10
Rate for Payer: Aetna Government	$183.10
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHYS/QHP 2-12 HR W/O VID

Facility

$0.01

Service Code	HCPCS 95717
Hospital Charge Code	41001015
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.31
Rate for Payer: Aetna Government	$89.31
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHYS/QHP 2-12 HR W/VEEG

Facility

$0.01

Service Code	HCPCS 95718
Hospital Charge Code	41001016
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.20
Rate for Payer: Aetna Government	$118.20
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG PHYS/QHP EA INCR W/O VID

Facility

$0.01

Service Code	HCPCS 95719
Hospital Charge Code	41001017
Hospital Revenue Code	740
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$139.38
Rate for Payer: Aetna Government	$139.38
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$822.00

EEG W/O VID 12-26 HR INTERMIT MON

Facility

$1,470.80

Service Code	HCPCS 95709
Hospital Charge Code	41001010
Hospital Revenue Code	740
Min. Negotiated Rate	$433.87
Max. Negotiated Rate	$1,176.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$619.82
Rate for Payer: Aetna Government	$619.82
Rate for Payer: Affinity Essential Plan 1&2	$433.87
Rate for Payer: Affinity Essential Plan 3&4	$433.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$433.87
Rate for Payer: Brighton Health Commercial	$1,103.10
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$619.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,000.14
Rate for Payer: Elderplan Medicare Advantage	$619.82
Rate for Payer: EmblemHealth Commercial	$619.82
Rate for Payer: Fidelis Essential Plan Aliesa	$526.85
Rate for Payer: Fidelis Essential Plan QHP	$551.64
Rate for Payer: Fidelis Medicare Advantage	$619.82
Rate for Payer: Fidelis Qualified Health Plan	$551.64
Rate for Payer: Group Health Inc Commercial	$619.82
Rate for Payer: Group Health Inc Medicare	$619.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.40
Rate for Payer: Hamaspik Choice Inc Medicare	$619.82
Rate for Payer: Healthfirst Medicare Advantage	$526.85
Rate for Payer: Healthfirst QHP	$619.82
Rate for Payer: Humana Medicare	$632.22
Rate for Payer: Senior Whole Health Medicare Advantage	$619.82
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$619.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$619.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$495.86
Rate for Payer: Wellcare Medicare	$588.83

EEG W/O VID 12-26 HR INTERMIT MON

Facility

$1,470.80

Service Code	HCPCS 95709
Hospital Charge Code	41001010
Hospital Revenue Code	740
Rate for Payer: Cash Price	$619.82

EEG W/O VID 12-26HR UNMONITORED

Facility

$1,470.80

Service Code	HCPCS 95708
Hospital Charge Code	41001009
Hospital Revenue Code	740
Rate for Payer: Cash Price	$619.82

EEG W/O VID 12-26HR UNMONITORED

Facility

$1,470.80

Service Code	HCPCS 95708
Hospital Charge Code	41001009
Hospital Revenue Code	740
Min. Negotiated Rate	$433.87
Max. Negotiated Rate	$1,176.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$619.82
Rate for Payer: Aetna Government	$619.82
Rate for Payer: Affinity Essential Plan 1&2	$433.87
Rate for Payer: Affinity Essential Plan 3&4	$433.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$433.87
Rate for Payer: Brighton Health Commercial	$1,103.10
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$619.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,000.14
Rate for Payer: Elderplan Medicare Advantage	$619.82
Rate for Payer: EmblemHealth Commercial	$619.82
Rate for Payer: Fidelis Essential Plan Aliesa	$526.85
Rate for Payer: Fidelis Essential Plan QHP	$551.64
Rate for Payer: Fidelis Medicare Advantage	$619.82
Rate for Payer: Fidelis Qualified Health Plan	$551.64
Rate for Payer: Group Health Inc Commercial	$619.82
Rate for Payer: Group Health Inc Medicare	$619.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.40
Rate for Payer: Hamaspik Choice Inc Medicare	$619.82
Rate for Payer: Healthfirst Medicare Advantage	$526.85
Rate for Payer: Healthfirst QHP	$619.82
Rate for Payer: Humana Medicare	$632.22
Rate for Payer: Senior Whole Health Medicare Advantage	$619.82
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$619.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$619.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$495.86
Rate for Payer: Wellcare Medicare	$588.83

EEG W/O VID 2-12 HR CONT MONITOR

Facility

$766.58

Service Code	HCPCS 95707
Hospital Charge Code	41001004
Hospital Revenue Code	740
Rate for Payer: Cash Price	$362.98

EEG W/O VID 2-12 HR CONT MONITOR

Facility

$766.58

Service Code	HCPCS 95707
Hospital Charge Code	41001004
Hospital Revenue Code	740
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

EEG W/O VID 2-12 HR INTERMIT MON

Facility

$766.58

Service Code	HCPCS 95706
Hospital Charge Code	41001003
Hospital Revenue Code	740
Rate for Payer: Cash Price	$362.98

EEG W/O VID 2-12 HR INTERMIT MON

Facility

$766.58

Service Code	HCPCS 95706
Hospital Charge Code	41001003
Hospital Revenue Code	740
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

EEG W/O VID 2-12 HR UNATTENDED

Facility

$1,470.80

Service Code	HCPCS 95714
Hospital Charge Code	41001002
Hospital Revenue Code	740
Rate for Payer: Cash Price	$619.82

EEG W/O VID 2-12 HR UNATTENDED

Facility

$1,470.80

Service Code	HCPCS 95714
Hospital Charge Code	41001002
Hospital Revenue Code	740
Min. Negotiated Rate	$433.87
Max. Negotiated Rate	$1,176.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$619.82
Rate for Payer: Aetna Government	$619.82
Rate for Payer: Affinity Essential Plan 1&2	$433.87
Rate for Payer: Affinity Essential Plan 3&4	$433.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$433.87
Rate for Payer: Brighton Health Commercial	$1,103.10
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$619.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,000.14
Rate for Payer: Elderplan Medicare Advantage	$619.82
Rate for Payer: EmblemHealth Commercial	$619.82
Rate for Payer: Fidelis Essential Plan Aliesa	$526.85
Rate for Payer: Fidelis Essential Plan QHP	$551.64
Rate for Payer: Fidelis Medicare Advantage	$619.82
Rate for Payer: Fidelis Qualified Health Plan	$551.64
Rate for Payer: Group Health Inc Commercial	$619.82
Rate for Payer: Group Health Inc Medicare	$619.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.40
Rate for Payer: Hamaspik Choice Inc Medicare	$619.82
Rate for Payer: Healthfirst Medicare Advantage	$526.85
Rate for Payer: Healthfirst QHP	$619.82
Rate for Payer: Humana Medicare	$632.22
Rate for Payer: Senior Whole Health Medicare Advantage	$619.82
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$619.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$619.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$495.86
Rate for Payer: Wellcare Medicare	$588.83

EEG W/O VID 2-12 HR UNMNTR

Facility

$814.65

Service Code	HCPCS 95705
Hospital Charge Code	41001011
Hospital Revenue Code	740
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$448.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$610.99
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$651.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$553.96
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$407.32
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$822.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

Know your out-of-pocket cost for care.

All Charges