St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEMORRHOIDECTOMY

Facility

$7,099.93

Service Code	HCPCS 46255
Hospital Charge Code	40010950
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$5,324.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,246.99
Rate for Payer: Aetna Government	$3,246.99
Rate for Payer: Affinity Essential Plan 1&2	$2,272.89
Rate for Payer: Affinity Essential Plan 3&4	$2,272.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,272.89
Rate for Payer: Brighton Health Commercial	$5,324.95
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,246.99
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	$3,246.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,759.94
Rate for Payer: Fidelis Essential Plan QHP	$2,889.82
Rate for Payer: Fidelis Medicare Advantage	$3,246.99
Rate for Payer: Fidelis Qualified Health Plan	$2,889.82
Rate for Payer: Group Health Inc Commercial	$3,246.99
Rate for Payer: Group Health Inc Medicare	$3,246.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,549.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3,246.99
Rate for Payer: Healthfirst Medicare Advantage	$2,759.94
Rate for Payer: Healthfirst QHP	$3,246.99
Rate for Payer: Humana Medicare	$3,311.93
Rate for Payer: Senior Whole Health Medicare Advantage	$3,246.99
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,246.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,246.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,597.59
Rate for Payer: Wellcare Medicare	$3,084.64

HEMORRHOIDECTOMY

Facility

$7,099.93

Service Code	HCPCS 46255
Hospital Charge Code	40010950
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,246.99

Hemorrhoidectomy, external, 2 or more columns/groups

Facility

$3,311.93

Service Code	CPT 46250
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,311.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,246.99
Rate for Payer: Aetna Government	$3,246.99
Rate for Payer: Affinity Essential Plan 1&2	$2,272.89
Rate for Payer: Affinity Essential Plan 3&4	$2,272.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,272.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,246.99
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	$3,246.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,759.94
Rate for Payer: Fidelis Essential Plan QHP	$2,889.82
Rate for Payer: Fidelis Medicare Advantage	$3,246.99
Rate for Payer: Fidelis Qualified Health Plan	$2,889.82
Rate for Payer: Group Health Inc Commercial	$3,246.99
Rate for Payer: Group Health Inc Medicare	$3,246.99
Rate for Payer: Hamaspik Choice Inc Medicare	$3,246.99
Rate for Payer: Healthfirst Medicare Advantage	$2,759.94
Rate for Payer: Healthfirst QHP	$3,246.99
Rate for Payer: Humana Medicare	$3,311.93
Rate for Payer: Senior Whole Health Medicare Advantage	$3,246.99
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,246.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,246.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,597.59
Rate for Payer: Wellcare Medicare	$3,084.64

Hemorrhoidectomy, internal and external, 2 or more columns/groups;

Facility

$3,311.93

Service Code	CPT 46260
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,311.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,246.99
Rate for Payer: Aetna Government	$3,246.99
Rate for Payer: Affinity Essential Plan 1&2	$2,272.89
Rate for Payer: Affinity Essential Plan 3&4	$2,272.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,272.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,246.99
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	$3,246.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,759.94
Rate for Payer: Fidelis Essential Plan QHP	$2,889.82
Rate for Payer: Fidelis Medicare Advantage	$3,246.99
Rate for Payer: Fidelis Qualified Health Plan	$2,889.82
Rate for Payer: Group Health Inc Commercial	$3,246.99
Rate for Payer: Group Health Inc Medicare	$3,246.99
Rate for Payer: Hamaspik Choice Inc Medicare	$3,246.99
Rate for Payer: Healthfirst Medicare Advantage	$2,759.94
Rate for Payer: Healthfirst QHP	$3,246.99
Rate for Payer: Humana Medicare	$3,311.93
Rate for Payer: Senior Whole Health Medicare Advantage	$3,246.99
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,246.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,246.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,597.59
Rate for Payer: Wellcare Medicare	$3,084.64

Hemorrhoidectomy, internal and external, single column/group;

Facility

$3,311.93

Service Code	CPT 46255
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$3,311.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,246.99
Rate for Payer: Aetna Government	$3,246.99
Rate for Payer: Affinity Essential Plan 1&2	$2,272.89
Rate for Payer: Affinity Essential Plan 3&4	$2,272.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,272.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,246.99
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	$3,246.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,759.94
Rate for Payer: Fidelis Essential Plan QHP	$2,889.82
Rate for Payer: Fidelis Medicare Advantage	$3,246.99
Rate for Payer: Fidelis Qualified Health Plan	$2,889.82
Rate for Payer: Group Health Inc Commercial	$3,246.99
Rate for Payer: Group Health Inc Medicare	$3,246.99
Rate for Payer: Hamaspik Choice Inc Medicare	$3,246.99
Rate for Payer: Healthfirst Medicare Advantage	$2,759.94
Rate for Payer: Healthfirst QHP	$3,246.99
Rate for Payer: Humana Medicare	$3,311.93
Rate for Payer: Senior Whole Health Medicare Advantage	$3,246.99
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,246.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,246.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,597.59
Rate for Payer: Wellcare Medicare	$3,084.64

HEMORRHOIDOPEXY BY STAPLING

Facility

$7,099.93

Service Code	HCPCS 46947
Hospital Charge Code	40019946
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$5,324.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,246.99
Rate for Payer: Aetna Government	$3,246.99
Rate for Payer: Affinity Essential Plan 1&2	$2,272.89
Rate for Payer: Affinity Essential Plan 3&4	$2,272.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,272.89
Rate for Payer: Brighton Health Commercial	$5,324.95
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Cash Price	$3,246.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,246.99
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	$3,246.99
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,759.94
Rate for Payer: Fidelis Essential Plan QHP	$2,889.82
Rate for Payer: Fidelis Medicare Advantage	$3,246.99
Rate for Payer: Fidelis Qualified Health Plan	$2,889.82
Rate for Payer: Group Health Inc Commercial	$3,246.99
Rate for Payer: Group Health Inc Medicare	$3,246.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,549.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3,246.99
Rate for Payer: Healthfirst Medicare Advantage	$2,759.94
Rate for Payer: Healthfirst QHP	$3,246.99
Rate for Payer: Humana Medicare	$3,311.93
Rate for Payer: Senior Whole Health Medicare Advantage	$3,246.99
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,246.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,246.99
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,597.59
Rate for Payer: Wellcare Medicare	$3,084.64

HEMORRHOIDOPEXY BY STAPLING

Facility

$7,099.93

Service Code	HCPCS 46947
Hospital Charge Code	40019946
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,246.99

HEMOSTASIS NU-KNIT 1X 1

Facility

$40.94

Hospital Charge Code	64904144
Hospital Revenue Code	270
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$32.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.47
Rate for Payer: Aetna Government	$20.47
Rate for Payer: Brighton Health Commercial	$30.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.84
Rate for Payer: Group Health Inc Commercial	$20.47
Rate for Payer: Group Health Inc Medicare	$14.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.47
Rate for Payer: Hamaspik Choice Inc Medicare	$20.47

HEMOSTASIS NU-KNIT 3X4 STERILE

Facility

$120.00

Hospital Charge Code	40206067
Hospital Revenue Code	270
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.00
Rate for Payer: Aetna Government	$60.00
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

HEMOSTASIS SURGIFOAM 100

Facility

$82.25

Hospital Charge Code	64904142
Hospital Revenue Code	270
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$65.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.12
Rate for Payer: Aetna Government	$41.12
Rate for Payer: Brighton Health Commercial	$61.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.93
Rate for Payer: Group Health Inc Commercial	$41.12
Rate for Payer: Group Health Inc Medicare	$28.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.12
Rate for Payer: Hamaspik Choice Inc Medicare	$41.12

HEMOSTASIS SURGIFOAM 12-7

Facility

$16.85

Hospital Charge Code	64904140
Hospital Revenue Code	270
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$13.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.42
Rate for Payer: Aetna Government	$8.42
Rate for Payer: Brighton Health Commercial	$12.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.46
Rate for Payer: Group Health Inc Commercial	$8.42
Rate for Payer: Group Health Inc Medicare	$5.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.42
Rate for Payer: Hamaspik Choice Inc Medicare	$8.42

HEMOSTASIS SURGIFOAM SZ 100

Facility

$82.25

Hospital Charge Code	64904029
Hospital Revenue Code	270
Min. Negotiated Rate	$28.79
Max. Negotiated Rate	$65.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.12
Rate for Payer: Aetna Government	$41.12
Rate for Payer: Brighton Health Commercial	$61.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.93
Rate for Payer: Group Health Inc Commercial	$41.12
Rate for Payer: Group Health Inc Medicare	$28.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.12
Rate for Payer: Hamaspik Choice Inc Medicare	$41.12

HEMOVAC

Facility

$78.68

Hospital Charge Code	40202417
Hospital Revenue Code	270
Min. Negotiated Rate	$27.54
Max. Negotiated Rate	$62.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.34
Rate for Payer: Aetna Government	$39.34
Rate for Payer: Brighton Health Commercial	$59.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.50
Rate for Payer: Group Health Inc Commercial	$39.34
Rate for Payer: Group Health Inc Medicare	$27.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.34
Rate for Payer: Hamaspik Choice Inc Medicare	$39.34

HEMOVAC LARGE 2590

Facility

$25.69

Hospital Charge Code	64901226
Hospital Revenue Code	270
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$20.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.84
Rate for Payer: Aetna Government	$12.84
Rate for Payer: Brighton Health Commercial	$19.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.47
Rate for Payer: Group Health Inc Commercial	$12.84
Rate for Payer: Group Health Inc Medicare	$8.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.84
Rate for Payer: Hamaspik Choice Inc Medicare	$12.84

HEMOVAC MEDIUM 2500

Facility

$19.93

Hospital Charge Code	64901224
Hospital Revenue Code	270
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$15.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.96
Rate for Payer: Aetna Government	$9.96
Rate for Payer: Brighton Health Commercial	$14.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.55
Rate for Payer: Group Health Inc Commercial	$9.96
Rate for Payer: Group Health Inc Medicare	$6.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.96
Rate for Payer: Hamaspik Choice Inc Medicare	$9.96

HEP A 720 EU/0.5ML SYR

Facility

$61.00

Service Code	HCPCS 90633
Hospital Charge Code	41649578
Hospital Revenue Code	636
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$30.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50

HEP A 720 EU/0.5ML SYR

Facility

$61.00

Service Code	HCPCS 90633
Hospital Charge Code	41659578
Hospital Revenue Code	636
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$39.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
Rate for Payer: Brighton Health Commercial	$36.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.08
Rate for Payer: Group Health Inc Commercial	$30.50
Rate for Payer: Group Health Inc Medicare	$21.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.65

HEP A 720 EU/0.5ML SYR

Facility

$61.00

Service Code	HCPCS 90633
Hospital Charge Code	41649578
Hospital Revenue Code	636
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$39.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.42
Rate for Payer: Aetna Government	$35.42
Rate for Payer: Brighton Health Commercial	$36.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.08
Rate for Payer: Group Health Inc Commercial	$30.50
Rate for Payer: Group Health Inc Medicare	$21.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.65

HEP A 720 EU/0.5ML SYR

Facility

$61.00

Service Code	HCPCS 90633
Hospital Charge Code	41659578
Hospital Revenue Code	636
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$30.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.50
Rate for Payer: Hamaspik Choice Inc Medicare	$30.50

HEP A AB, IGM

Facility

$28.15

Service Code	HCPCS 86709
Hospital Charge Code	40729372
Hospital Revenue Code	300
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$21.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.26
Rate for Payer: Aetna Government	$11.26
Rate for Payer: Affinity Essential Plan 1&2	$7.88
Rate for Payer: Affinity Essential Plan 3&4	$7.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.88
Rate for Payer: Brighton Health Commercial	$21.11
Rate for Payer: Cash Price	$11.26
Rate for Payer: Cash Price	$11.26
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.15
Rate for Payer: Elderplan Medicare Advantage	$11.26
Rate for Payer: EmblemHealth Commercial	$11.26
Rate for Payer: Fidelis Essential Plan Aliesa	$9.57
Rate for Payer: Fidelis Essential Plan QHP	$10.02
Rate for Payer: Fidelis Medicare Advantage	$11.26
Rate for Payer: Fidelis Qualified Health Plan	$10.02
Rate for Payer: Group Health Inc Commercial	$11.26
Rate for Payer: Group Health Inc Medicare	$11.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.08
Rate for Payer: Hamaspik Choice Inc Medicare	$11.26
Rate for Payer: Healthfirst Medicare Advantage	$11.26
Rate for Payer: Healthfirst QHP	$11.26
Rate for Payer: Humana Medicare	$11.49
Rate for Payer: Senior Whole Health Medicare Advantage	$11.26
Rate for Payer: United Healthcare Commercial	$14.26
Rate for Payer: United Healthcare Medicare Advantage	$11.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.01
Rate for Payer: Wellcare Medicare	$10.13

HEP A AB, IGM

Facility

$28.15

Service Code	HCPCS 86709
Hospital Charge Code	40729372
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.26

HEP A AB TOTAL

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40729709
Hospital Revenue Code	302
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$23.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.39
Rate for Payer: Aetna Government	$12.39
Rate for Payer: Affinity Essential Plan 1&2	$8.67
Rate for Payer: Affinity Essential Plan 3&4	$8.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.67
Rate for Payer: Brighton Health Commercial	$23.24
Rate for Payer: Cash Price	$12.39
Rate for Payer: Cash Price	$12.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.66
Rate for Payer: Elderplan Medicare Advantage	$12.39
Rate for Payer: EmblemHealth Commercial	$12.39
Rate for Payer: Fidelis Essential Plan Aliesa	$10.53
Rate for Payer: Fidelis Essential Plan QHP	$11.03
Rate for Payer: Fidelis Medicare Advantage	$12.39
Rate for Payer: Fidelis Qualified Health Plan	$11.03
Rate for Payer: Group Health Inc Commercial	$12.39
Rate for Payer: Group Health Inc Medicare	$12.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.49
Rate for Payer: Hamaspik Choice Inc Medicare	$12.39
Rate for Payer: Healthfirst Medicare Advantage	$12.39
Rate for Payer: Healthfirst QHP	$12.39
Rate for Payer: Humana Medicare	$12.64
Rate for Payer: Senior Whole Health Medicare Advantage	$12.39
Rate for Payer: United Healthcare Commercial	$15.69
Rate for Payer: United Healthcare Medicare Advantage	$12.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.91
Rate for Payer: Wellcare Medicare	$11.15

HEP A AB TOTAL

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40729709
Hospital Revenue Code	302
Rate for Payer: Cash Price	$12.39

HEP A/ HEP B VACC ADULT

Facility

$48.56

Service Code	HCPCS 90636
Hospital Charge Code	30305047
Hospital Revenue Code	636
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$24.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28

HEP A/ HEP B VACC ADULT

Facility

$48.56

Service Code	HCPCS 90636
Hospital Charge Code	30305047
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$114.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.35
Rate for Payer: Aetna Government	$114.35
Rate for Payer: Brighton Health Commercial	$29.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.92
Rate for Payer: Group Health Inc Commercial	$24.28
Rate for Payer: Group Health Inc Medicare	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.56

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