St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLEXICARE BED T3000

Facility

$124.04

Hospital Charge Code	40209120
Hospital Revenue Code	270
Min. Negotiated Rate	$43.41
Max. Negotiated Rate	$99.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.02
Rate for Payer: Aetna Government	$62.02
Rate for Payer: Brighton Health Commercial	$93.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.35
Rate for Payer: Group Health Inc Commercial	$62.02
Rate for Payer: Group Health Inc Medicare	$43.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.02
Rate for Payer: Hamaspik Choice Inc Medicare	$62.02

FLEXI-SEAL FECAL COLLECTOR

Facility

$108.30

Hospital Charge Code	64901975
Hospital Revenue Code	270
Min. Negotiated Rate	$37.90
Max. Negotiated Rate	$86.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.15
Rate for Payer: Aetna Government	$54.15
Rate for Payer: Brighton Health Commercial	$81.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$86.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.64
Rate for Payer: Group Health Inc Commercial	$54.15
Rate for Payer: Group Health Inc Medicare	$37.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.15
Rate for Payer: Hamaspik Choice Inc Medicare	$54.15

FLEXIVA 365

Facility

$792.00

Service Code	HCPCS C1713
Hospital Charge Code	64903011
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$831.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$435.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$475.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$396.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$455.40
Rate for Payer: EmblemHealth Commercial	$396.00
Rate for Payer: Fidelis Medicare Advantage	$831.60
Rate for Payer: Group Health Inc Commercial	$396.00
Rate for Payer: Group Health Inc Medicare	$277.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.00
Rate for Payer: Hamaspik Choice Inc Medicare	$396.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$514.80

FLEXIVA 365

Facility

$792.00

Service Code	HCPCS C1713
Hospital Charge Code	64903011
Hospital Revenue Code	278
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$396.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.00
Rate for Payer: Hamaspik Choice Inc Medicare	$396.00

FLEXIVA TRAC TIP 200

Facility

$1,151.88

Hospital Charge Code	64903013
Hospital Revenue Code	279
Min. Negotiated Rate	$403.16
Max. Negotiated Rate	$921.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$633.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$575.94
Rate for Payer: Aetna Government	$575.94
Rate for Payer: Brighton Health Commercial	$863.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$921.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$783.28
Rate for Payer: Group Health Inc Commercial	$575.94
Rate for Payer: Group Health Inc Medicare	$403.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$575.94
Rate for Payer: Hamaspik Choice Inc Medicare	$575.94

FL G.I. AIR W/O KUB

Facility

$551.90

Service Code	HCPCS 74246 TC
Hospital Charge Code	41102504
Hospital Revenue Code	320
Min. Negotiated Rate	$146.86
Max. Negotiated Rate	$303.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.47
Rate for Payer: Aetna Government	$212.47
Rate for Payer: Affinity Essential Plan 1&2	$148.73
Rate for Payer: Affinity Essential Plan 3&4	$148.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$148.73
Rate for Payer: Brighton Health Commercial	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.86
Rate for Payer: Elderplan Medicare Advantage	$212.47
Rate for Payer: EmblemHealth Commercial	$148.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$180.60
Rate for Payer: Fidelis Essential Plan Aliesa	$180.60
Rate for Payer: Fidelis Essential Plan QHP	$189.10
Rate for Payer: Fidelis Medicare Advantage	$212.47
Rate for Payer: Fidelis Qualified Health Plan	$189.10
Rate for Payer: Group Health Inc Commercial	$191.22
Rate for Payer: Group Health Inc Medicare	$191.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$212.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.22
Rate for Payer: Healthfirst Medicare Advantage	$212.47
Rate for Payer: Healthfirst QHP	$212.47
Rate for Payer: Humana Medicare	$216.72
Rate for Payer: Senior Whole Health Medicare Advantage	$212.47
Rate for Payer: United Healthcare Medicare Advantage	$212.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.98
Rate for Payer: Wellcare Medicare	$201.85

FL G.I. AIR W/O KUB

Facility

$551.90

Service Code	HCPCS 74246 TC
Hospital Charge Code	41102504
Hospital Revenue Code	320
Rate for Payer: Cash Price	$212.47

FL G.I. SERIES W/O KUB

Facility

$551.90

Service Code	HCPCS 74240 TC
Hospital Charge Code	41102114
Hospital Revenue Code	320
Rate for Payer: Cash Price	$212.47

FL G.I. SERIES W/O KUB

Facility

$551.90

Service Code	HCPCS 74240 TC
Hospital Charge Code	41102114
Hospital Revenue Code	320
Min. Negotiated Rate	$146.86
Max. Negotiated Rate	$780.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.47
Rate for Payer: Aetna Government	$212.47
Rate for Payer: Affinity Essential Plan 1&2	$148.73
Rate for Payer: Affinity Essential Plan 3&4	$148.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$148.73
Rate for Payer: Brighton Health Commercial	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.86
Rate for Payer: Elderplan Medicare Advantage	$212.47
Rate for Payer: EmblemHealth Commercial	$148.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$180.60
Rate for Payer: Fidelis Essential Plan Aliesa	$180.60
Rate for Payer: Fidelis Essential Plan QHP	$189.10
Rate for Payer: Fidelis Medicare Advantage	$212.47
Rate for Payer: Fidelis Qualified Health Plan	$189.10
Rate for Payer: Group Health Inc Commercial	$191.22
Rate for Payer: Group Health Inc Medicare	$191.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$212.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.22
Rate for Payer: Healthfirst Medicare Advantage	$212.47
Rate for Payer: Healthfirst QHP	$212.47
Rate for Payer: Humana Medicare	$216.72
Rate for Payer: Senior Whole Health Medicare Advantage	$212.47
Rate for Payer: United Healthcare Medicare Advantage	$212.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.98
Rate for Payer: Wellcare Medicare	$201.85

FLIP CUTTER 10.0 MM

Facility

$812.50

Hospital Charge Code	64905993
Hospital Revenue Code	270
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$406.25
Rate for Payer: Aetna Government	$406.25
Rate for Payer: Brighton Health Commercial	$609.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.50
Rate for Payer: Group Health Inc Commercial	$406.25
Rate for Payer: Group Health Inc Medicare	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25

FLIPCUTTER 10.5

Facility

$812.50

Hospital Charge Code	64905946
Hospital Revenue Code	270
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$406.25
Rate for Payer: Aetna Government	$406.25
Rate for Payer: Brighton Health Commercial	$609.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.50
Rate for Payer: Group Health Inc Commercial	$406.25
Rate for Payer: Group Health Inc Medicare	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25

FLIP CUTTER 11.0 MM

Facility

$812.50

Hospital Charge Code	64906030
Hospital Revenue Code	270
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$406.25
Rate for Payer: Aetna Government	$406.25
Rate for Payer: Brighton Health Commercial	$609.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.50
Rate for Payer: Group Health Inc Commercial	$406.25
Rate for Payer: Group Health Inc Medicare	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25

FLIP CUTTER II 8.5MM

Facility

$812.50

Hospital Charge Code	64905348
Hospital Revenue Code	270
Min. Negotiated Rate	$284.38
Max. Negotiated Rate	$650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$406.25
Rate for Payer: Aetna Government	$406.25
Rate for Payer: Brighton Health Commercial	$609.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$650.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.50
Rate for Payer: Group Health Inc Commercial	$406.25
Rate for Payer: Group Health Inc Medicare	$284.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$406.25
Rate for Payer: Hamaspik Choice Inc Medicare	$406.25

FLOSEAL HEMOSTATIC MATRIX 5ML

Facility

$376.12

Hospital Charge Code	40200986
Hospital Revenue Code	270
Min. Negotiated Rate	$131.64
Max. Negotiated Rate	$300.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$188.06
Rate for Payer: Aetna Government	$188.06
Rate for Payer: Brighton Health Commercial	$282.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$300.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$255.76
Rate for Payer: Group Health Inc Commercial	$188.06
Rate for Payer: Group Health Inc Medicare	$131.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$188.06
Rate for Payer: Hamaspik Choice Inc Medicare	$188.06

FLOUROURACIL 500MG/10ML INJ

Facility

$3.00

Service Code	HCPCS J9190
Hospital Charge Code	41650748
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.13
Rate for Payer: SOMOS Essential	$3.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

FLOUROURACIL 500MG/10ML INJ

Facility

$3.00

Service Code	HCPCS J9190
Hospital Charge Code	41640748
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

FLOUROURACIL 500MG/10ML INJ

Facility

$3.00

Service Code	HCPCS J9190
Hospital Charge Code	41640748
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$3.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.13
Rate for Payer: SOMOS Essential	$3.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

FLOUROURACIL 500MG/10ML INJ

Facility

$3.00

Service Code	HCPCS J9190
Hospital Charge Code	41650748
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

FLOW COUPLER 4MM

Facility

$2,237.50

Hospital Charge Code	64904351
Hospital Revenue Code	279
Min. Negotiated Rate	$783.12
Max. Negotiated Rate	$1,790.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,230.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,118.75
Rate for Payer: Aetna Government	$1,118.75
Rate for Payer: Brighton Health Commercial	$1,678.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,790.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,521.50
Rate for Payer: Group Health Inc Commercial	$1,118.75
Rate for Payer: Group Health Inc Medicare	$783.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,118.75

FLOWCYTOMETRY/READ 16 & >

Facility

$212.96

Service Code	HCPCS 88189
Hospital Charge Code	30305420
Hospital Revenue Code	311
Min. Negotiated Rate	$68.82
Max. Negotiated Rate	$159.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.82
Rate for Payer: Aetna Government	$68.82
Rate for Payer: Brighton Health Commercial	$159.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.72
Rate for Payer: Group Health Inc Commercial	$106.48
Rate for Payer: Group Health Inc Medicare	$74.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.48
Rate for Payer: Hamaspik Choice Inc Medicare	$106.48

FLOWTRON STOCKING

Facility

$73.35

Hospital Charge Code	40204880
Hospital Revenue Code	270
Min. Negotiated Rate	$25.67
Max. Negotiated Rate	$58.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.68
Rate for Payer: Aetna Government	$36.68
Rate for Payer: Brighton Health Commercial	$55.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.88
Rate for Payer: Group Health Inc Commercial	$36.68
Rate for Payer: Group Health Inc Medicare	$25.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.68
Rate for Payer: Hamaspik Choice Inc Medicare	$36.68

FLOW VOL LOOP

Facility

$766.58

Service Code	HCPCS 94375 TC
Hospital Charge Code	40402708
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

FLOW VOL LOOP

Facility

$766.58

Service Code	HCPCS 94375 TC
Hospital Charge Code	40402708
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

FL SMALL BOWEL SERIES

Facility

$551.90

Service Code	HCPCS 74250 TC
Hospital Charge Code	41102122
Hospital Revenue Code	320
Min. Negotiated Rate	$146.86
Max. Negotiated Rate	$303.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$212.47
Rate for Payer: Aetna Government	$212.47
Rate for Payer: Affinity Essential Plan 1&2	$148.73
Rate for Payer: Affinity Essential Plan 3&4	$148.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$148.73
Rate for Payer: Brighton Health Commercial	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Cash Price	$212.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$212.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.86
Rate for Payer: Elderplan Medicare Advantage	$212.47
Rate for Payer: EmblemHealth Commercial	$148.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$180.60
Rate for Payer: Fidelis Essential Plan Aliesa	$180.60
Rate for Payer: Fidelis Essential Plan QHP	$189.10
Rate for Payer: Fidelis Medicare Advantage	$212.47
Rate for Payer: Fidelis Qualified Health Plan	$189.10
Rate for Payer: Group Health Inc Commercial	$191.22
Rate for Payer: Group Health Inc Medicare	$191.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.95
Rate for Payer: Hamaspik Choice Inc Medicare	$212.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.22
Rate for Payer: Healthfirst Medicare Advantage	$212.47
Rate for Payer: Healthfirst QHP	$212.47
Rate for Payer: Humana Medicare	$216.72
Rate for Payer: Senior Whole Health Medicare Advantage	$212.47
Rate for Payer: United Healthcare Medicare Advantage	$212.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.98
Rate for Payer: Wellcare Medicare	$201.85

FL SMALL BOWEL SERIES

Facility

$551.90

Service Code	HCPCS 74250 TC
Hospital Charge Code	41102122
Hospital Revenue Code	320
Rate for Payer: Cash Price	$212.47

Know your out-of-pocket cost for care.

All Charges