St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EV3 BALLOON DILAT NANO 2.0X150CM

Facility

$550.00

Service Code	HCPCS C1725
Hospital Charge Code	40008270
Hospital Revenue Code	272
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$412.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

EV3 NANOCROSS ELT 2.5-3MM X 210MM

Facility

$550.00

Service Code	HCPCS C1725
Hospital Charge Code	40005241
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$577.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.85
Rate for Payer: Aetna Government	$44.85
Rate for Payer: Brighton Health Commercial	$330.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$316.25
Rate for Payer: EmblemHealth Commercial	$275.00
Rate for Payer: Fidelis Medicare Advantage	$577.50
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$357.50

EV3 NANOCROSS ELT 2.5-3MM X 210MM

Facility

$550.00

Service Code	HCPCS C1725
Hospital Charge Code	40005241
Hospital Revenue Code	278
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

EV3 PERIPH PLAQUE EXC SYS

Facility

$5,990.00

Service Code	HCPCS C1714
Hospital Charge Code	40008302
Hospital Revenue Code	278
Min. Negotiated Rate	$2,995.00
Max. Negotiated Rate	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,995.00

EV3 PERIPH PLAQUE EXC SYS

Facility

$5,990.00

Service Code	HCPCS C1714
Hospital Charge Code	40008302
Hospital Revenue Code	278
Min. Negotiated Rate	$599.91
Max. Negotiated Rate	$6,289.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,294.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$599.91
Rate for Payer: Aetna Government	$599.91
Rate for Payer: Brighton Health Commercial	$3,594.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,995.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,444.25
Rate for Payer: EmblemHealth Commercial	$2,995.00
Rate for Payer: Fidelis Medicare Advantage	$6,289.50
Rate for Payer: Group Health Inc Commercial	$2,995.00
Rate for Payer: Group Health Inc Medicare	$2,096.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,995.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,893.50

EVACUATED CONTAINER 1000CC

Facility

$6.73

Hospital Charge Code	40505205
Hospital Revenue Code	260
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$76.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: United Healthcare Commercial	$76.00

EVACUATED CONTNR-1000 ML

Facility

$22.98

Hospital Charge Code	64901803
Hospital Revenue Code	270
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$18.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.49
Rate for Payer: Aetna Government	$11.49
Rate for Payer: Brighton Health Commercial	$17.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.63
Rate for Payer: Group Health Inc Commercial	$11.49
Rate for Payer: Group Health Inc Medicare	$8.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.49
Rate for Payer: Hamaspik Choice Inc Medicare	$11.49

EVACUATED GLASS CONTAINER

Facility

$10.00

Hospital Charge Code	41652190
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

EVACUATED GLASS CONTAINER

Facility

$10.00

Hospital Charge Code	41642190
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

EVACUATION HEMATOMA

Facility

$5,632.75

Service Code	HCPCS 61312
Hospital Charge Code	40011175
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$4,224.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,098.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,640.06
Rate for Payer: Aetna Government	$2,640.06
Rate for Payer: Brighton Health Commercial	$4,224.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$2,816.38
Rate for Payer: Group Health Inc Medicare	$1,971.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,816.38
Rate for Payer: Hamaspik Choice Inc Medicare	$2,816.38
Rate for Payer: United Healthcare Commercial	$1,496.00

EVAL FOR SGD - FIRST 60 MINUTES

Facility

$375.15

Service Code	HCPCS 92607
Hospital Charge Code	41905002
Hospital Revenue Code	444
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$18,926.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$108.92
Rate for Payer: Aetna Government	$108.92
Rate for Payer: Affinity Essential Plan 1&2	$425.84
Rate for Payer: Affinity Essential Plan 3&4	$425.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$189.26
Rate for Payer: Amida Care Medicaid	$189.26
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,926.00
Rate for Payer: Fidelis Essential Plan Aliesa	$189.26
Rate for Payer: Fidelis Essential Plan QHP	$189.26
Rate for Payer: Fidelis Qualified Health Plan	$198.72
Rate for Payer: Group Health Inc Commercial	$187.58
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.26
Rate for Payer: Hamaspik Choice Inc Medicare	$187.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$189.26
Rate for Payer: Healthfirst Essential Plan	$425.84
Rate for Payer: Healthfirst QHP	$189.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.26
Rate for Payer: SOMOS Essential	$425.84
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$425.84
Rate for Payer: United Healthcare Essential Plan 3&4	$208.19
Rate for Payer: United Healthcare Medicaid	$189.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$189.26
Rate for Payer: Wellcare Medicare	$55.00

EVAL FOR VOICE PROSTHESIS

Facility

$211.43

Service Code	HCPCS 92597
Hospital Charge Code	41905005
Hospital Revenue Code	444
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$18,926.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$61.99
Rate for Payer: Aetna Government	$61.99
Rate for Payer: Affinity Essential Plan 1&2	$425.84
Rate for Payer: Affinity Essential Plan 3&4	$425.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$189.26
Rate for Payer: Amida Care Medicaid	$189.26
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,926.00
Rate for Payer: Fidelis Essential Plan Aliesa	$189.26
Rate for Payer: Fidelis Essential Plan QHP	$189.26
Rate for Payer: Fidelis Qualified Health Plan	$198.72
Rate for Payer: Group Health Inc Commercial	$105.72
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.26
Rate for Payer: Hamaspik Choice Inc Medicare	$105.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$189.26
Rate for Payer: Healthfirst Essential Plan	$425.84
Rate for Payer: Healthfirst QHP	$189.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.26
Rate for Payer: SOMOS Essential	$425.84
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$425.84
Rate for Payer: United Healthcare Essential Plan 3&4	$208.19
Rate for Payer: United Healthcare Medicaid	$189.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$189.26
Rate for Payer: Wellcare Medicare	$55.00

EVAL IMPL PUMP WO PROGR

Facility

$820.53

Service Code	HCPCS 62367
Hospital Charge Code	30305082
Hospital Revenue Code	510
Rate for Payer: Cash Price	$345.41

EVAL IMPL PUMP WO PROGR

Facility

$820.53

Service Code	HCPCS 62367
Hospital Charge Code	30305082
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$345.41
Rate for Payer: Aetna Government	$345.41
Rate for Payer: Affinity Essential Plan 1&2	$241.79
Rate for Payer: Affinity Essential Plan 3&4	$241.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$241.79
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$345.41
Rate for Payer: Cash Price	$345.41
Rate for Payer: Cash Price	$345.41
Rate for Payer: Cash Price	$345.41
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$345.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$345.41
Rate for Payer: Fidelis Essential Plan Aliesa	$293.60
Rate for Payer: Fidelis Essential Plan QHP	$307.41
Rate for Payer: Fidelis Medicare Advantage	$345.41
Rate for Payer: Fidelis Qualified Health Plan	$307.41
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	$410.26
Rate for Payer: Hamaspik Choice Inc Medicare	$345.41
Rate for Payer: Healthfirst Medicare Advantage	$293.60
Rate for Payer: Healthfirst QHP	$345.41
Rate for Payer: Humana Medicare	$352.32
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$345.41
Rate for Payer: Senior Whole Health Medicare Advantage	$345.41
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$345.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$345.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$276.33
Rate for Payer: Wellcare Medicare	$328.14

EVAL IMPL PUMP W PROGR

Facility

$820.53

Service Code	HCPCS 62368
Hospital Charge Code	30301655
Hospital Revenue Code	510
Rate for Payer: Cash Price	$345.41

EVAL IMPL PUMP W PROGR

Facility

$820.53

Service Code	HCPCS 62368
Hospital Charge Code	30301655
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$345.41
Rate for Payer: Aetna Government	$345.41
Rate for Payer: Affinity Essential Plan 1&2	$241.79
Rate for Payer: Affinity Essential Plan 3&4	$241.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$241.79
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$345.41
Rate for Payer: Cash Price	$345.41
Rate for Payer: Cash Price	$345.41
Rate for Payer: Cash Price	$345.41
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$345.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$345.41
Rate for Payer: Fidelis Essential Plan Aliesa	$293.60
Rate for Payer: Fidelis Essential Plan QHP	$307.41
Rate for Payer: Fidelis Medicare Advantage	$345.41
Rate for Payer: Fidelis Qualified Health Plan	$307.41
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	$410.26
Rate for Payer: Hamaspik Choice Inc Medicare	$345.41
Rate for Payer: Healthfirst Medicare Advantage	$293.60
Rate for Payer: Healthfirst QHP	$345.41
Rate for Payer: Humana Medicare	$352.32
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$345.41
Rate for Payer: Senior Whole Health Medicare Advantage	$345.41
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$345.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$345.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$276.33
Rate for Payer: Wellcare Medicare	$328.14

EVAL ORAL/PHARYNGEAL/SWALLOW

Facility

$209.85

Service Code	HCPCS 92610
Hospital Charge Code	41902140
Hospital Revenue Code	440
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.34
Rate for Payer: Aetna Government	$62.34
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$104.92
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.92
Rate for Payer: Hamaspik Choice Inc Medicare	$104.92
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

EVAL SAC

Facility

$6.73

Hospital Charge Code	40201515
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.58
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

EVALUATE PT USE OF INHALER

Facility

$557.18

Service Code	HCPCS 94664
Hospital Charge Code	30305687
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

EVALUATE PT USE OF INHALER

Facility

$557.18

Service Code	HCPCS 94664
Hospital Charge Code	30305687
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

EVALUATION OF WHEEZING

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	30305955
Hospital Revenue Code	460
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$613.26
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: 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	$383.29
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

EVALUATION OF WHEEZING

Facility

$766.58

Service Code	HCPCS 94060 TC
Hospital Charge Code	30305955
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

EVERA XT VR DEFRIB

Facility

$41,450.00

Service Code	HCPCS C1722
Hospital Charge Code	66574664
Hospital Revenue Code	275
Min. Negotiated Rate	$3,988.80
Max. Negotiated Rate	$43,522.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,797.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,988.80
Rate for Payer: Aetna Government	$3,988.80
Rate for Payer: Brighton Health Commercial	$24,870.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20,725.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,833.75
Rate for Payer: EmblemHealth Commercial	$20,725.00
Rate for Payer: Fidelis Medicare Advantage	$43,522.50
Rate for Payer: Group Health Inc Commercial	$20,725.00
Rate for Payer: Group Health Inc Medicare	$14,507.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,725.00
Rate for Payer: Hamaspik Choice Inc Medicare	$20,725.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,942.50

EVERC .035' OTW PTA 5 FR DIA CATH

Facility

$220.00

Service Code	HCPCS C1726
Hospital Charge Code	40004628
Hospital Revenue Code	278
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$121.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.43
Rate for Payer: Aetna Government	$17.43
Rate for Payer: Brighton Health Commercial	$132.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$110.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$126.50
Rate for Payer: EmblemHealth Commercial	$110.00
Rate for Payer: Fidelis Medicare Advantage	$231.00
Rate for Payer: Group Health Inc Commercial	$110.00
Rate for Payer: Group Health Inc Medicare	$77.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$143.00

EVERC .035' OTW PTA 5 FR DIA CATH

Facility

$220.00

Service Code	HCPCS C1726
Hospital Charge Code	40004628
Hospital Revenue Code	278
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$110.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$110.00
Rate for Payer: Hamaspik Choice Inc Medicare	$110.00

Know your out-of-pocket cost for care.

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