St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KETAMINE 25MG/0.5ML SYRINGE

Facility

$0.32

Hospital Charge Code	41647828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.16
Rate for Payer: Aetna Government	$0.16
Rate for Payer: Brighton Health Commercial	$0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: Group Health Inc Commercial	$0.16
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

KETAMINE 500MG/NS 110ML

Facility

$17.40

Service Code	HCPCS J3490
Hospital Charge Code	41640347
Hospital Revenue Code	636
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.70
Rate for Payer: Hamaspik Choice Inc Medicare	$8.70

KETAMINE 500MG/NS 110ML

Facility

$17.40

Service Code	HCPCS J3490
Hospital Charge Code	41640347
Hospital Revenue Code	636
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$11.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.70
Rate for Payer: Aetna Government	$8.70
Rate for Payer: Brighton Health Commercial	$10.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.00
Rate for Payer: Group Health Inc Commercial	$8.70
Rate for Payer: Group Health Inc Medicare	$6.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.70
Rate for Payer: Hamaspik Choice Inc Medicare	$8.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.31

KETAMINE 500MG/NS 110ML

Facility

$17.40

Service Code	HCPCS J3490
Hospital Charge Code	41650347
Hospital Revenue Code	636
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.70
Rate for Payer: Hamaspik Choice Inc Medicare	$8.70

KETAMINE 500MG/NS 110ML

Facility

$17.40

Service Code	HCPCS J3490
Hospital Charge Code	41650347
Hospital Revenue Code	636
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$11.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.70
Rate for Payer: Aetna Government	$8.70
Rate for Payer: Brighton Health Commercial	$10.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.00
Rate for Payer: Group Health Inc Commercial	$8.70
Rate for Payer: Group Health Inc Medicare	$6.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.70
Rate for Payer: Hamaspik Choice Inc Medicare	$8.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.31

KETAMINE 50 MG/ML INJ

Facility

$5.94

Hospital Charge Code	41653552
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$4.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Brighton Health Commercial	$4.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.04
Rate for Payer: Group Health Inc Commercial	$2.97
Rate for Payer: Group Health Inc Medicare	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.97
Rate for Payer: Hamaspik Choice Inc Medicare	$2.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.86

KETAMINE 50 MG/ML INJ

Facility

$5.94

Hospital Charge Code	41643552
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$4.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.97
Rate for Payer: Aetna Government	$2.97
Rate for Payer: Brighton Health Commercial	$4.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.04
Rate for Payer: Group Health Inc Commercial	$2.97
Rate for Payer: Group Health Inc Medicare	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.97
Rate for Payer: Hamaspik Choice Inc Medicare	$2.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.86

KETAMINE HCL 100 MG/ML IJ SOLN [4237]

Facility

$3.06

Service Code	NDC 00143950910
Hospital Charge Code	00143950910
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.53
Rate for Payer: Aetna Government	$1.53
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

KETAMINE HCL 100 MG/ML IJ SOLN [4237]

Facility

$3.06

Service Code	NDC 00143950901
Hospital Charge Code	00143950901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.53
Rate for Payer: Aetna Government	$1.53
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

KETAMINE HCL 100 MG/ML IJ SOLN [4237]

Facility

$4.50

Service Code	NDC 09999123440
Hospital Charge Code	00143950901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$3.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.25
Rate for Payer: Aetna Government	$2.25
Rate for Payer: Brighton Health Commercial	$3.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.06
Rate for Payer: Group Health Inc Commercial	$2.25
Rate for Payer: Group Health Inc Medicare	$1.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.92

KETAMINE HCL 10 MG/ML IJ SOLN [4236]

Facility

$0.96

Service Code	NDC 69374030805
Hospital Charge Code	69374030805
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.65
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.62

KETAMINE HCL 10 MG/ML IJ SOLN [4236]

Facility

$1.19

Service Code	NDC 42023011310
Hospital Charge Code	42023011310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

KETAMINE HCL 10 MG/ML IJ SOLN [4236]

Facility

$1.21

Service Code	NDC 55150043801
Hospital Charge Code	55150043801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

KETAMINE HCL 30 MG/3ML IJ SOSY [162739]

Facility

$1.60

Service Code	NDC 69374098233
Hospital Charge Code	69374098233
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

KETAMINE HCL 50 MG/ML IJ SOLN [4238]

Facility

$0.55

Service Code	NDC 72572032001
Hospital Charge Code	72572032001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.28
Rate for Payer: Aetna Government	$0.28
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

KETAMINE HCL 50 MG/ML IJ SOLN [4238]

Facility

$0.84

Service Code	NDC 42023011410
Hospital Charge Code	42023011410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

KETAMINE HCL 50 MG/ML IJ SOSY [166579]

Facility

$5.40

Service Code	NDC 69374051101
Hospital Charge Code	69374051101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$4.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.70
Rate for Payer: Aetna Government	$2.70
Rate for Payer: Brighton Health Commercial	$4.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.67
Rate for Payer: Group Health Inc Commercial	$2.70
Rate for Payer: Group Health Inc Medicare	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.70
Rate for Payer: Hamaspik Choice Inc Medicare	$2.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.51

KETAMINE HCL 50 MG/ML IJ SOSY [166579]

Facility

$6.00

Service Code	NDC 63037013725
Hospital Charge Code	63037013725
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

KETAMINE HCL IN NACL 500 MG/110ML-% IV SOLN [192980]

Facility

$49.45

Service Code	NDC 09999123499
Hospital Revenue Code	278
Min. Negotiated Rate	$24.72
Max. Negotiated Rate	$24.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.72
Rate for Payer: Hamaspik Choice Inc Medicare	$24.72

KETAMINE HCL IN NACL 500 MG/110ML-% IV SOLN [192980]

Facility

$49.45

Service Code	NDC 09999123499
Hospital Revenue Code	278
Min. Negotiated Rate	$17.31
Max. Negotiated Rate	$51.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.72
Rate for Payer: Aetna Government	$24.72
Rate for Payer: Brighton Health Commercial	$29.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.43
Rate for Payer: EmblemHealth Commercial	$24.72
Rate for Payer: Fidelis Medicare Advantage	$51.92
Rate for Payer: Group Health Inc Commercial	$24.72
Rate for Payer: Group Health Inc Medicare	$17.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.72
Rate for Payer: Hamaspik Choice Inc Medicare	$24.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.14

KETOCONAZOLE 200 MG PO TABS [10369]

Facility

$3.79

Service Code	NDC 35573043330
Hospital Charge Code	35573043330
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$3.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.90
Rate for Payer: Aetna Government	$1.90
Rate for Payer: Brighton Health Commercial	$2.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.58
Rate for Payer: Group Health Inc Commercial	$1.90
Rate for Payer: Group Health Inc Medicare	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.46

KETOCONAZOLE 200MG TAB

Facility

$0.23

Hospital Charge Code	41648040
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

KETOCONAZOLE 200MG TAB

Facility

$0.23

Hospital Charge Code	41658040
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.15

KETOCONAZOLE 2 % EX CREA [10368]

Facility

$4.62

Service Code	NDC 51672129803
Hospital Charge Code	51672129803
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.31
Rate for Payer: Aetna Government	$2.31
Rate for Payer: Brighton Health Commercial	$3.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.14
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

KETOCONAZOLE 2 % EX CREA [10368]

Facility

$2.06

Service Code	NDC 00168009915
Hospital Charge Code	00168009915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.03
Rate for Payer: Aetna Government	$1.03
Rate for Payer: Brighton Health Commercial	$1.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.40
Rate for Payer: Group Health Inc Commercial	$1.03
Rate for Payer: Group Health Inc Medicare	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.03
Rate for Payer: Hamaspik Choice Inc Medicare	$1.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.34

Know your out-of-pocket cost for care.

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