St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EVERC 6 X 40MM DIALAT CATH

Facility

$220.00

Service Code	HCPCS C1726
Hospital Charge Code	40004627
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 6 X 40MM DIALAT CATH

Facility

$220.00

Service Code	HCPCS C1726
Hospital Charge Code	40004627
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

EVEROLIMUS

Facility

$34.33

Service Code	HCPCS 80169
Hospital Charge Code	40609810
Hospital Revenue Code	301
Rate for Payer: Cash Price	$13.73

EVEROLIMUS

Facility

$34.33

Service Code	HCPCS 80169
Hospital Charge Code	40609810
Hospital Revenue Code	301
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$27.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.73
Rate for Payer: Aetna Government	$13.73
Rate for Payer: Affinity Essential Plan 1&2	$9.61
Rate for Payer: Affinity Essential Plan 3&4	$9.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.61
Rate for Payer: Brighton Health Commercial	$25.75
Rate for Payer: Cash Price	$13.73
Rate for Payer: Cash Price	$13.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.34
Rate for Payer: Elderplan Medicare Advantage	$13.73
Rate for Payer: EmblemHealth Commercial	$13.73
Rate for Payer: Fidelis Essential Plan Aliesa	$11.67
Rate for Payer: Fidelis Essential Plan QHP	$12.22
Rate for Payer: Fidelis Medicare Advantage	$13.73
Rate for Payer: Fidelis Qualified Health Plan	$12.22
Rate for Payer: Group Health Inc Commercial	$13.73
Rate for Payer: Group Health Inc Medicare	$13.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.16
Rate for Payer: Hamaspik Choice Inc Medicare	$13.73
Rate for Payer: Healthfirst Medicare Advantage	$13.73
Rate for Payer: Healthfirst QHP	$13.73
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Senior Whole Health Medicare Advantage	$13.73
Rate for Payer: United Healthcare Commercial	$16.86
Rate for Payer: United Healthcare Medicare Advantage	$13.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.98
Rate for Payer: Wellcare Medicare	$12.36

EVEROLIMUS 0.5 MG PO TABS [104877]

Facility

$20.07

Service Code	HCPCS J7527
Hospital Charge Code	67877071933
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$16.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.92
Rate for Payer: Aetna Government	$5.92
Rate for Payer: Brighton Health Commercial	$15.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.65
Rate for Payer: Group Health Inc Commercial	$10.04
Rate for Payer: Group Health Inc Medicare	$7.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.04
Rate for Payer: Hamaspik Choice Inc Medicare	$10.04
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2.68
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2.85
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$2.85
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$2.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.05

EVEROLLIMUS STENT 2.5X33MM-4X38MM

Facility

$4,050.00

Service Code	HCPCS C1874
Hospital Charge Code	66529834
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,025.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,025.00

EVEROLLIMUS STENT 2.5X33MM-4X38MM

Facility

$4,050.00

Service Code	HCPCS C1874
Hospital Charge Code	66529834
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$4,252.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,227.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Brighton Health Commercial	$2,430.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,025.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,328.75
Rate for Payer: EmblemHealth Commercial	$2,025.00
Rate for Payer: Fidelis Medicare Advantage	$4,252.50
Rate for Payer: Group Health Inc Commercial	$2,025.00
Rate for Payer: Group Health Inc Medicare	$1,417.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,025.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,025.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,632.50

EVOKED AUDITORY TEST QUAL

Facility

$174.30

Service Code	HCPCS 92558
Hospital Charge Code	42004528
Hospital Revenue Code	471
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$158.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.06
Rate for Payer: Aetna Government	$9.06
Rate for Payer: Brighton Health Commercial	$130.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$139.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$118.52
Rate for Payer: Group Health Inc Commercial	$87.15
Rate for Payer: Group Health Inc Medicare	$61.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.15
Rate for Payer: Hamaspik Choice Inc Medicare	$87.15
Rate for Payer: United Healthcare Commercial	$158.00

EVOLUTION VALVE INSTALLED

Facility

$400.00

Hospital Charge Code	64904020
Hospital Revenue Code	270
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

EVP INDC ARRYTH ELEC PAC

Facility

$2,991.08

Service Code	HCPCS 93618 TC
Hospital Charge Code	66574578
Hospital Revenue Code	480
Min. Negotiated Rate	$316.00
Max. Negotiated Rate	$2,392.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,645.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,376.30
Rate for Payer: Aetna Government	$1,376.30
Rate for Payer: Affinity Essential Plan 1&2	$963.41
Rate for Payer: Affinity Essential Plan 3&4	$963.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$963.41
Rate for Payer: Brighton Health Commercial	$2,243.31
Rate for Payer: Cash Price	$1,376.30
Rate for Payer: Cash Price	$1,376.30
Rate for Payer: Cash Price	$1,376.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,376.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,392.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,033.93
Rate for Payer: Elderplan Medicare Advantage	$1,376.30
Rate for Payer: EmblemHealth Commercial	$1,376.30
Rate for Payer: Fidelis Essential Plan Aliesa	$1,169.86
Rate for Payer: Fidelis Essential Plan QHP	$1,224.91
Rate for Payer: Fidelis Medicare Advantage	$1,376.30
Rate for Payer: Fidelis Qualified Health Plan	$1,224.91
Rate for Payer: Group Health Inc Commercial	$1,376.30
Rate for Payer: Group Health Inc Medicare	$1,376.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,495.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1,376.30
Rate for Payer: Healthfirst Medicare Advantage	$1,169.86
Rate for Payer: Healthfirst QHP	$1,376.30
Rate for Payer: Humana Medicare	$1,403.83
Rate for Payer: Senior Whole Health Medicare Advantage	$1,376.30
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$1,376.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,376.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,101.04
Rate for Payer: Wellcare Medicare	$1,307.48

EVP INDC ARRYTH ELEC PAC

Facility

$2,991.08

Service Code	HCPCS 93618 TC
Hospital Charge Code	66574578
Hospital Revenue Code	480
Rate for Payer: Cash Price	$1,376.30

EVP IV INFUSION, INITAL 1ST HR

Facility

$556.50

Service Code	HCPCS 96365 TC
Hospital Charge Code	66574661
Hospital Revenue Code	940
Rate for Payer: Cash Price	$247.87

EVP IV INFUSION, INITAL 1ST HR

Facility

$556.50

Service Code	HCPCS 96365 TC
Hospital Charge Code	66574661
Hospital Revenue Code	940
Min. Negotiated Rate	$173.51
Max. Negotiated Rate	$445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$247.87
Rate for Payer: Aetna Government	$247.87
Rate for Payer: Affinity Essential Plan 1&2	$173.51
Rate for Payer: Affinity Essential Plan 3&4	$173.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$173.51
Rate for Payer: Brighton Health Commercial	$417.38
Rate for Payer: Cash Price	$247.87
Rate for Payer: Cash Price	$247.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$247.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$445.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.42
Rate for Payer: Elderplan Medicare Advantage	$247.87
Rate for Payer: EmblemHealth Commercial	$247.87
Rate for Payer: Fidelis Essential Plan Aliesa	$210.69
Rate for Payer: Fidelis Essential Plan QHP	$220.60
Rate for Payer: Fidelis Medicare Advantage	$247.87
Rate for Payer: Fidelis Qualified Health Plan	$220.60
Rate for Payer: Group Health Inc Commercial	$247.87
Rate for Payer: Group Health Inc Medicare	$247.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.25
Rate for Payer: Hamaspik Choice Inc Medicare	$247.87
Rate for Payer: Healthfirst Medicare Advantage	$210.69
Rate for Payer: Healthfirst QHP	$247.87
Rate for Payer: Humana Medicare	$252.83
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$247.87
Rate for Payer: Senior Whole Health Medicare Advantage	$247.87
Rate for Payer: United Healthcare Commercial	$278.25
Rate for Payer: United Healthcare Medicare Advantage	$247.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$247.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$198.30
Rate for Payer: Wellcare Medicare	$235.48

EX01 ANIMAL MIX

Facility

$19.93

Service Code	HCPCS 86005
Hospital Charge Code	40729324
Hospital Revenue Code	300
Rate for Payer: Cash Price	$7.97

EX01 ANIMAL MIX

Facility

$19.93

Service Code	HCPCS 86005
Hospital Charge Code	40729324
Hospital Revenue Code	300
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$14.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.97
Rate for Payer: Aetna Government	$7.97
Rate for Payer: Affinity Essential Plan 1&2	$5.58
Rate for Payer: Affinity Essential Plan 3&4	$5.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.58
Rate for Payer: Brighton Health Commercial	$14.95
Rate for Payer: Cash Price	$7.97
Rate for Payer: Cash Price	$7.97
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.72
Rate for Payer: Elderplan Medicare Advantage	$7.97
Rate for Payer: EmblemHealth Commercial	$7.97
Rate for Payer: Fidelis Essential Plan Aliesa	$6.77
Rate for Payer: Fidelis Essential Plan QHP	$7.09
Rate for Payer: Fidelis Medicare Advantage	$7.97
Rate for Payer: Fidelis Qualified Health Plan	$7.09
Rate for Payer: Group Health Inc Commercial	$7.97
Rate for Payer: Group Health Inc Medicare	$7.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96
Rate for Payer: Hamaspik Choice Inc Medicare	$7.97
Rate for Payer: Healthfirst Medicare Advantage	$7.97
Rate for Payer: Healthfirst QHP	$7.97
Rate for Payer: Humana Medicare	$8.13
Rate for Payer: Senior Whole Health Medicare Advantage	$7.97
Rate for Payer: United Healthcare Commercial	$10.10
Rate for Payer: United Healthcare Medicare Advantage	$7.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.38
Rate for Payer: Wellcare Medicare	$7.17

EXAM UNDER ANESTHESIA - PELVIC

Facility

$7,566.13

Service Code	HCPCS 57410
Hospital Charge Code	40059990
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,615.39

EXAM UNDER ANESTHESIA - PELVIC

Facility

$7,566.13

Service Code	HCPCS 57410
Hospital Charge Code	40059990
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$5,674.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,615.39
Rate for Payer: Aetna Government	$3,615.39
Rate for Payer: Affinity Essential Plan 1&2	$2,530.77
Rate for Payer: Affinity Essential Plan 3&4	$2,530.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,530.77
Rate for Payer: Brighton Health Commercial	$5,674.60
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Cash Price	$3,615.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,615.39
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	$3,615.39
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,073.08
Rate for Payer: Fidelis Essential Plan QHP	$3,217.70
Rate for Payer: Fidelis Medicare Advantage	$3,615.39
Rate for Payer: Fidelis Qualified Health Plan	$3,217.70
Rate for Payer: Group Health Inc Commercial	$3,615.39
Rate for Payer: Group Health Inc Medicare	$3,615.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,783.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3,615.39
Rate for Payer: Healthfirst Medicare Advantage	$3,073.08
Rate for Payer: Healthfirst QHP	$3,615.39
Rate for Payer: Humana Medicare	$3,687.70
Rate for Payer: Senior Whole Health Medicare Advantage	$3,615.39
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,615.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,615.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,892.31
Rate for Payer: Wellcare Medicare	$3,434.62

EXC BAKERS CYST

Facility

$8,291.05

Service Code	HCPCS 27345
Hospital Charge Code	40011180
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

EXC BAKERS CYST

Facility

$8,291.05

Service Code	HCPCS 27345
Hospital Charge Code	40011180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

EXC EXCESS DIGITS POLYDACT

Facility

$529.23

Service Code	HCPCS 11200
Hospital Charge Code	40019580
Hospital Revenue Code	360
Rate for Payer: Cash Price	$231.52

EXC EXCESS DIGITS POLYDACT

Facility

$529.23

Service Code	HCPCS 11200
Hospital Charge Code	40019580
Hospital Revenue Code	360
Min. Negotiated Rate	$162.06
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$231.52
Rate for Payer: Aetna Government	$231.52
Rate for Payer: Affinity Essential Plan 1&2	$162.06
Rate for Payer: Affinity Essential Plan 3&4	$162.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$162.06
Rate for Payer: Brighton Health Commercial	$396.92
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Cash Price	$231.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$231.52
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	$231.52
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$196.79
Rate for Payer: Fidelis Essential Plan QHP	$206.05
Rate for Payer: Fidelis Medicare Advantage	$231.52
Rate for Payer: Fidelis Qualified Health Plan	$206.05
Rate for Payer: Group Health Inc Commercial	$231.52
Rate for Payer: Group Health Inc Medicare	$231.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$264.62
Rate for Payer: Hamaspik Choice Inc Medicare	$231.52
Rate for Payer: Healthfirst Medicare Advantage	$196.79
Rate for Payer: Healthfirst QHP	$231.52
Rate for Payer: Humana Medicare	$236.15
Rate for Payer: Senior Whole Health Medicare Advantage	$231.52
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$231.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$231.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$185.22
Rate for Payer: Wellcare Medicare	$219.94

EXC EXT THROMB HEMORRHOIDS

Facility

$3,041.53

Service Code	HCPCS 46320
Hospital Charge Code	30307893
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,364.66
Rate for Payer: Aetna Government	$1,364.66
Rate for Payer: Affinity Essential Plan 1&2	$955.26
Rate for Payer: Affinity Essential Plan 3&4	$955.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$955.26
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Cash Price	$1,364.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,364.66
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	$1,364.66
Rate for Payer: Fidelis Essential Plan Aliesa	$1,159.96
Rate for Payer: Fidelis Essential Plan QHP	$1,214.55
Rate for Payer: Fidelis Medicare Advantage	$1,364.66
Rate for Payer: Fidelis Qualified Health Plan	$1,214.55
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	$1,520.76
Rate for Payer: Hamaspik Choice Inc Medicare	$1,364.66
Rate for Payer: Healthfirst Medicare Advantage	$1,159.96
Rate for Payer: Healthfirst QHP	$1,364.66
Rate for Payer: Humana Medicare	$1,391.95
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,364.66
Rate for Payer: Senior Whole Health Medicare Advantage	$1,364.66
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,364.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,364.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,091.73
Rate for Payer: Wellcare Medicare	$1,296.43

EXC EXT THROMB HEMORRHOIDS

Facility

$3,041.53

Service Code	HCPCS 46320
Hospital Charge Code	30307893
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,364.66

EXC EXT THROMBOSED HEMORRHOIDS

Facility

$3,041.53

Service Code	HCPCS 46320
Hospital Charge Code	40019717
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,364.66

EXC EXT THROMBOSED HEMORRHOIDS

Facility

$3,041.53

Service Code	HCPCS 46320
Hospital Charge Code	30302457
Hospital Revenue Code	450
Rate for Payer: Cash Price	$1,364.66

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