St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CETIRIZINE HCL 5 MG PO TABS

Facility

$2.49

Service Code	NDC 1657140110
Hospital Charge Code	1657140110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.25
Rate for Payer: Aetna Government	$1.25
Rate for Payer: Brighton Health Commercial	$1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.70
Rate for Payer: EmblemHealth Commercial	$1.25
Rate for Payer: Group Health Inc Commercial	$1.25
Rate for Payer: Group Health Inc Medicare	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.62

CETIRIZINE HCL 5 MG PO TABS

Facility

$2.49

Service Code	NDC 1657140110
Hospital Charge Code	1657140110
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25

CETUXIMAB 100 MG/50ML IV SOLN

Facility

$18.92

Service Code	HCPCS J9055
Hospital Charge Code	6673394823
Hospital Revenue Code	258
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$9.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.46

CETUXIMAB 100 MG/50ML IV SOLN

Facility

$18.92

Service Code	HCPCS J9055
Hospital Charge Code	6673394823
Hospital Revenue Code	258
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$79.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.37
Rate for Payer: Aetna Government	$78.37
Rate for Payer: Affinity Essential Plan 1&2	$54.86
Rate for Payer: Affinity Essential Plan 3&4	$54.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$54.86
Rate for Payer: Brighton Health Commercial	$14.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$78.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.87
Rate for Payer: Elderplan Medicare Advantage	$78.37
Rate for Payer: EmblemHealth Commercial	$78.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70.53
Rate for Payer: Fidelis Essential Plan Aliesa	$66.61
Rate for Payer: Fidelis Essential Plan QHP	$69.75
Rate for Payer: Fidelis Medicare Advantage	$78.37
Rate for Payer: Fidelis Qualified Health Plan	$69.75
Rate for Payer: Group Health Inc Commercial	$78.37
Rate for Payer: Group Health Inc Medicare	$78.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$78.37
Rate for Payer: Healthfirst Medicare Advantage	$66.61
Rate for Payer: Healthfirst QHP	$78.37
Rate for Payer: Humana Medicare	$79.94
Rate for Payer: Senior Whole Health Medicare Advantage	$78.37
Rate for Payer: United Healthcare Medicare Advantage	$78.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.45
Rate for Payer: Wellcare Medicare	$74.45

CETUXIMAB 200 MG/100ML IV SOLN

Facility

$18.92

Service Code	HCPCS J9055
Hospital Charge Code	6673395823
Hospital Revenue Code	258
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$9.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.46

CETUXIMAB 200 MG/100ML IV SOLN

Facility

$18.92

Service Code	HCPCS J9055
Hospital Charge Code	6673395823
Hospital Revenue Code	258
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$79.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$78.37
Rate for Payer: Aetna Government	$78.37
Rate for Payer: Affinity Essential Plan 1&2	$54.86
Rate for Payer: Affinity Essential Plan 3&4	$54.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$54.86
Rate for Payer: Brighton Health Commercial	$14.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$78.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.87
Rate for Payer: Elderplan Medicare Advantage	$78.37
Rate for Payer: EmblemHealth Commercial	$78.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70.53
Rate for Payer: Fidelis Essential Plan Aliesa	$66.61
Rate for Payer: Fidelis Essential Plan QHP	$69.75
Rate for Payer: Fidelis Medicare Advantage	$78.37
Rate for Payer: Fidelis Qualified Health Plan	$69.75
Rate for Payer: Group Health Inc Commercial	$78.37
Rate for Payer: Group Health Inc Medicare	$78.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$78.37
Rate for Payer: Hamaspik Choice Inc Medicare	$78.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$78.37
Rate for Payer: Healthfirst Medicare Advantage	$66.61
Rate for Payer: Healthfirst QHP	$78.37
Rate for Payer: Humana Medicare	$79.94
Rate for Payer: Senior Whole Health Medicare Advantage	$78.37
Rate for Payer: United Healthcare Medicare Advantage	$78.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$74.45
Rate for Payer: Wellcare Medicare	$74.45

CHARCOAL ACTIVATED PO LIQD

Facility

$0.17

Service Code	NDC 6668920108
Hospital Charge Code	6668920108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

CHARCOAL ACTIVATED PO LIQD

Facility

$0.17

Service Code	NDC 6668920108
Hospital Charge Code	6668920108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

CHARCOAL ACTIVATED PO LIQD

Facility

$0.14

Service Code	NDC 0574052174
Hospital Charge Code	0574052174
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

CHARCOAL ACTIVATED PO LIQD

Facility

$0.17

Service Code	NDC 6668920208
Hospital Charge Code	6668920208
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

CHARCOAL ACTIVATED PO LIQD

Facility

$0.10

Service Code	NDC 0574052176
Hospital Charge Code	0574052176
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

CHARCOAL ACTIVATED PO LIQD

Facility

$0.14

Service Code	NDC 0574052174
Hospital Charge Code	0574052174
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

CHARCOAL ACTIVATED PO LIQD

Facility

$0.17

Service Code	NDC 6668920208
Hospital Charge Code	6668920208
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

CHARCOAL ACTIVATED PO LIQD

Facility

$0.10

Service Code	NDC 0574052176
Hospital Charge Code	0574052176
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

CHEMOTHERAPY

Facility

$278.49

Service Code	EAPG 00803
Min. Negotiated Rate	$201.34
Max. Negotiated Rate	$278.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$201.34
Rate for Payer: Healthfirst Commercial	$278.49

Chemotherapy for acute leukemia #

Facility

$47,954.43

Service Code	APR-DRG 6952
Min. Negotiated Rate	$21,313.08
Max. Negotiated Rate	$47,954.43
Rate for Payer: Affinity Essential Plan 1&2	$47,954.43
Rate for Payer: Affinity Essential Plan 3&4	$47,954.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,313.08
Rate for Payer: Amida Care Medicaid	$21,313.08
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,954.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,313.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,313.08
Rate for Payer: Fidelis Qualified Health Plan	$25,575.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,313.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,313.08
Rate for Payer: Healthfirst Essential Plan	$47,954.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,313.08
Rate for Payer: SOMOS Essential	$47,954.43
Rate for Payer: United Healthcare Essential Plan 1&2	$47,954.43
Rate for Payer: United Healthcare Essential Plan 3&4	$47,954.43
Rate for Payer: United Healthcare Medicaid	$21,313.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,313.08

Chemotherapy for acute leukemia #

Facility

$161,931.73

Service Code	APR-DRG 6954
Min. Negotiated Rate	$71,969.66
Max. Negotiated Rate	$161,931.73
Rate for Payer: Affinity Essential Plan 1&2	$161,931.73
Rate for Payer: Affinity Essential Plan 3&4	$161,931.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$71,969.66
Rate for Payer: Amida Care Medicaid	$71,969.66
Rate for Payer: EmblemHealth Essential Plan 1&2	$161,931.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$71,969.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$71,969.66
Rate for Payer: Fidelis Qualified Health Plan	$86,363.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$71,969.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71,969.66
Rate for Payer: Healthfirst Essential Plan	$161,931.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71,969.66
Rate for Payer: SOMOS Essential	$161,931.73
Rate for Payer: United Healthcare Essential Plan 1&2	$161,931.73
Rate for Payer: United Healthcare Essential Plan 3&4	$161,931.73
Rate for Payer: United Healthcare Medicaid	$71,969.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71,969.66

Chemotherapy for acute leukemia #

Facility

$74,894.90

Service Code	APR-DRG 6953
Min. Negotiated Rate	$33,286.62
Max. Negotiated Rate	$74,894.90
Rate for Payer: Affinity Essential Plan 1&2	$74,894.90
Rate for Payer: Affinity Essential Plan 3&4	$74,894.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,286.62
Rate for Payer: Amida Care Medicaid	$33,286.62
Rate for Payer: EmblemHealth Essential Plan 1&2	$74,894.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,286.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,286.62
Rate for Payer: Fidelis Qualified Health Plan	$39,943.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,286.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,286.62
Rate for Payer: Healthfirst Essential Plan	$74,894.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,286.62
Rate for Payer: SOMOS Essential	$74,894.90
Rate for Payer: United Healthcare Essential Plan 1&2	$74,894.90
Rate for Payer: United Healthcare Essential Plan 3&4	$74,894.90
Rate for Payer: United Healthcare Medicaid	$33,286.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,286.62

Chemotherapy for acute leukemia #

Facility

$47,931.57

Service Code	APR-DRG 6951
Min. Negotiated Rate	$21,302.92
Max. Negotiated Rate	$47,931.57
Rate for Payer: Affinity Essential Plan 1&2	$47,931.57
Rate for Payer: Affinity Essential Plan 3&4	$47,931.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,302.92
Rate for Payer: Amida Care Medicaid	$21,302.92
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,931.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,302.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,302.92
Rate for Payer: Fidelis Qualified Health Plan	$25,563.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,302.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,302.92
Rate for Payer: Healthfirst Essential Plan	$47,931.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,302.92
Rate for Payer: SOMOS Essential	$47,931.57
Rate for Payer: United Healthcare Essential Plan 1&2	$47,931.57
Rate for Payer: United Healthcare Essential Plan 3&4	$47,931.57
Rate for Payer: United Healthcare Medicaid	$21,302.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,302.92

Chest pain

Facility

$73,438.65

Service Code	APR-DRG 2034
Min. Negotiated Rate	$11,434.00
Max. Negotiated Rate	$73,438.65
Rate for Payer: Affinity Essential Plan 1&2	$73,438.65
Rate for Payer: Affinity Essential Plan 3&4	$73,438.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,639.40
Rate for Payer: Amida Care Medicaid	$32,639.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$73,438.65
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,639.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,639.40
Rate for Payer: Fidelis Qualified Health Plan	$39,167.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,639.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,639.40
Rate for Payer: Healthfirst Commercial	$33,028.00
Rate for Payer: Healthfirst Essential Plan	$73,438.65
Rate for Payer: Healthfirst QHP	$11,434.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,639.40
Rate for Payer: SOMOS Essential	$73,438.65
Rate for Payer: United Healthcare Essential Plan 1&2	$73,438.65
Rate for Payer: United Healthcare Essential Plan 3&4	$73,438.65
Rate for Payer: United Healthcare Medicaid	$32,639.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,639.40

Chest pain

Facility

$44,431.65

Service Code	APR-DRG 2033
Min. Negotiated Rate	$7,173.00
Max. Negotiated Rate	$44,431.65
Rate for Payer: Affinity Essential Plan 1&2	$44,431.65
Rate for Payer: Affinity Essential Plan 3&4	$44,431.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,747.40
Rate for Payer: Amida Care Medicaid	$19,747.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,431.65
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,747.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,747.40
Rate for Payer: Fidelis Qualified Health Plan	$23,696.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,747.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,747.40
Rate for Payer: Healthfirst Commercial	$13,552.00
Rate for Payer: Healthfirst Essential Plan	$44,431.65
Rate for Payer: Healthfirst QHP	$7,173.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,747.40
Rate for Payer: SOMOS Essential	$44,431.65
Rate for Payer: United Healthcare Essential Plan 1&2	$44,431.65
Rate for Payer: United Healthcare Essential Plan 3&4	$44,431.65
Rate for Payer: United Healthcare Medicaid	$19,747.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,747.40

Chest pain

Facility

$38,942.62

Service Code	APR-DRG 2031
Min. Negotiated Rate	$4,791.00
Max. Negotiated Rate	$38,942.62
Rate for Payer: Affinity Essential Plan 1&2	$38,942.62
Rate for Payer: Affinity Essential Plan 3&4	$38,942.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,307.83
Rate for Payer: Amida Care Medicaid	$17,307.83
Rate for Payer: EmblemHealth Essential Plan 1&2	$38,942.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,307.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,307.83
Rate for Payer: Fidelis Qualified Health Plan	$20,769.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,307.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,307.83
Rate for Payer: Healthfirst Commercial	$8,351.00
Rate for Payer: Healthfirst Essential Plan	$38,942.62
Rate for Payer: Healthfirst QHP	$4,791.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,307.83
Rate for Payer: SOMOS Essential	$38,942.62
Rate for Payer: United Healthcare Essential Plan 1&2	$38,942.62
Rate for Payer: United Healthcare Essential Plan 3&4	$38,942.62
Rate for Payer: United Healthcare Medicaid	$17,307.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,307.83

Chest pain

Facility

$40,657.39

Service Code	APR-DRG 2032
Min. Negotiated Rate	$5,575.00
Max. Negotiated Rate	$40,657.39
Rate for Payer: Affinity Essential Plan 1&2	$40,657.39
Rate for Payer: Affinity Essential Plan 3&4	$40,657.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,069.95
Rate for Payer: Amida Care Medicaid	$18,069.95
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,657.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,069.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,069.95
Rate for Payer: Fidelis Qualified Health Plan	$21,683.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,069.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,069.95
Rate for Payer: Healthfirst Commercial	$9,770.00
Rate for Payer: Healthfirst Essential Plan	$40,657.39
Rate for Payer: Healthfirst QHP	$5,575.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,069.95
Rate for Payer: SOMOS Essential	$40,657.39
Rate for Payer: United Healthcare Essential Plan 1&2	$40,657.39
Rate for Payer: United Healthcare Essential Plan 3&4	$40,657.39
Rate for Payer: United Healthcare Medicaid	$18,069.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,069.95

CHEST PAIN

Facility

$291.36

Service Code	EAPG 00604
Min. Negotiated Rate	$210.60
Max. Negotiated Rate	$291.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$210.60
Rate for Payer: Healthfirst Commercial	$291.36

CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

Professional

Both

$2,007.29

Service Code	HCPCS 77295
Min. Negotiated Rate	$387.18
Max. Negotiated Rate	$1,244.50
Rate for Payer: Cash Price	$553.46
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$553.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$497.80
Rate for Payer: Fidelis Essential Plan Aliesa	$497.80
Rate for Payer: Fidelis Essential Plan QHP	$525.45
Rate for Payer: Fidelis Medicare Advantage	$553.11
Rate for Payer: Fidelis Qualified Health Plan	$525.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$553.11
Rate for Payer: Hamaspik Choice Inc Medicare	$553.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$414.83
Rate for Payer: Healthfirst Commercial	$553.11
Rate for Payer: Healthfirst Essential Plan	$1,244.50
Rate for Payer: Healthfirst Medicare Advantage	$525.45
Rate for Payer: Healthfirst QHP	$553.11
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$387.18
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$553.11
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$470.14
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$387.18
Rate for Payer: Senior Whole Health Medicare Advantage	$553.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$414.83
Rate for Payer: SOMOS Essential	$414.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$553.11

Know your out-of-pocket cost for care.

All Charges