St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LEAD BLANK

Facility

$187.50

Hospital Charge Code	64906026
Hospital Revenue Code	270
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$103.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$93.75
Rate for Payer: Aetna Government	$93.75
Rate for Payer: Brighton Health Commercial	$140.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.50
Rate for Payer: Group Health Inc Commercial	$93.75
Rate for Payer: Group Health Inc Medicare	$65.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$93.75
Rate for Payer: Hamaspik Choice Inc Medicare	$93.75

LEAD, BLOOD

Facility

$30.28

Service Code	HCPCS 83655
Hospital Charge Code	40608043
Hospital Revenue Code	301
Rate for Payer: Cash Price	$12.11

LEAD, BLOOD

Facility

$30.28

Service Code	HCPCS 83655
Hospital Charge Code	40608043
Hospital Revenue Code	301
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$1,515.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.11
Rate for Payer: Aetna Government	$12.11
Rate for Payer: Affinity Essential Plan 1&2	$34.09
Rate for Payer: Affinity Essential Plan 3&4	$34.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.15
Rate for Payer: Amida Care Medicaid	$15.15
Rate for Payer: Brighton Health Commercial	$22.71
Rate for Payer: Cash Price	$12.11
Rate for Payer: Cash Price	$12.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.27
Rate for Payer: Elderplan Medicare Advantage	$12.11
Rate for Payer: EmblemHealth Commercial	$12.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,515.00
Rate for Payer: Fidelis Essential Plan Aliesa	$15.15
Rate for Payer: Fidelis Essential Plan QHP	$15.15
Rate for Payer: Fidelis Medicare Advantage	$12.11
Rate for Payer: Fidelis Qualified Health Plan	$15.91
Rate for Payer: Group Health Inc Commercial	$12.11
Rate for Payer: Group Health Inc Medicare	$12.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.15
Rate for Payer: Hamaspik Choice Inc Medicare	$12.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.15
Rate for Payer: Healthfirst Essential Plan	$34.09
Rate for Payer: Healthfirst Medicare Advantage	$12.11
Rate for Payer: Healthfirst QHP	$15.15
Rate for Payer: Humana Medicare	$12.35
Rate for Payer: Senior Whole Health Medicare Advantage	$12.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.15
Rate for Payer: SOMOS Essential	$15.15
Rate for Payer: United Healthcare Commercial	$15.33
Rate for Payer: United Healthcare Essential Plan 1&2	$34.09
Rate for Payer: United Healthcare Essential Plan 3&4	$16.66
Rate for Payer: United Healthcare Medicaid	$15.15
Rate for Payer: United Healthcare Medicare Advantage	$12.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.69
Rate for Payer: Wellcare Medicare	$10.90

LEAD, BLOOD (ADULT)

Facility

$30.28

Service Code	HCPCS 83655
Hospital Charge Code	40609095
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.11

LEAD, BLOOD (ADULT)

Facility

$30.28

Service Code	HCPCS 83655
Hospital Charge Code	40609095
Hospital Revenue Code	300
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$1,515.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.11
Rate for Payer: Aetna Government	$12.11
Rate for Payer: Affinity Essential Plan 1&2	$34.09
Rate for Payer: Affinity Essential Plan 3&4	$34.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.15
Rate for Payer: Amida Care Medicaid	$15.15
Rate for Payer: Brighton Health Commercial	$22.71
Rate for Payer: Cash Price	$12.11
Rate for Payer: Cash Price	$12.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.27
Rate for Payer: Elderplan Medicare Advantage	$12.11
Rate for Payer: EmblemHealth Commercial	$12.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,515.00
Rate for Payer: Fidelis Essential Plan Aliesa	$15.15
Rate for Payer: Fidelis Essential Plan QHP	$15.15
Rate for Payer: Fidelis Medicare Advantage	$12.11
Rate for Payer: Fidelis Qualified Health Plan	$15.91
Rate for Payer: Group Health Inc Commercial	$12.11
Rate for Payer: Group Health Inc Medicare	$12.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.15
Rate for Payer: Hamaspik Choice Inc Medicare	$12.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.15
Rate for Payer: Healthfirst Essential Plan	$34.09
Rate for Payer: Healthfirst Medicare Advantage	$12.11
Rate for Payer: Healthfirst QHP	$15.15
Rate for Payer: Humana Medicare	$12.35
Rate for Payer: Senior Whole Health Medicare Advantage	$12.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.15
Rate for Payer: SOMOS Essential	$15.15
Rate for Payer: United Healthcare Commercial	$15.33
Rate for Payer: United Healthcare Essential Plan 1&2	$34.09
Rate for Payer: United Healthcare Essential Plan 3&4	$16.66
Rate for Payer: United Healthcare Medicaid	$15.15
Rate for Payer: United Healthcare Medicare Advantage	$12.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.69
Rate for Payer: Wellcare Medicare	$10.90

LEAD BLOOD PEDIATRIC

Facility

$30.28

Service Code	HCPCS 83655
Hospital Charge Code	40608850
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.11

LEAD BLOOD PEDIATRIC

Facility

$30.28

Service Code	HCPCS 83655
Hospital Charge Code	40608850
Hospital Revenue Code	300
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$1,515.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.11
Rate for Payer: Aetna Government	$12.11
Rate for Payer: Affinity Essential Plan 1&2	$34.09
Rate for Payer: Affinity Essential Plan 3&4	$34.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.15
Rate for Payer: Amida Care Medicaid	$15.15
Rate for Payer: Brighton Health Commercial	$22.71
Rate for Payer: Cash Price	$12.11
Rate for Payer: Cash Price	$12.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.27
Rate for Payer: Elderplan Medicare Advantage	$12.11
Rate for Payer: EmblemHealth Commercial	$12.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,515.00
Rate for Payer: Fidelis Essential Plan Aliesa	$15.15
Rate for Payer: Fidelis Essential Plan QHP	$15.15
Rate for Payer: Fidelis Medicare Advantage	$12.11
Rate for Payer: Fidelis Qualified Health Plan	$15.91
Rate for Payer: Group Health Inc Commercial	$12.11
Rate for Payer: Group Health Inc Medicare	$12.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.15
Rate for Payer: Hamaspik Choice Inc Medicare	$12.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.15
Rate for Payer: Healthfirst Essential Plan	$34.09
Rate for Payer: Healthfirst Medicare Advantage	$12.11
Rate for Payer: Healthfirst QHP	$15.15
Rate for Payer: Humana Medicare	$12.35
Rate for Payer: Senior Whole Health Medicare Advantage	$12.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.15
Rate for Payer: SOMOS Essential	$15.15
Rate for Payer: United Healthcare Commercial	$15.33
Rate for Payer: United Healthcare Essential Plan 1&2	$34.09
Rate for Payer: United Healthcare Essential Plan 3&4	$16.66
Rate for Payer: United Healthcare Medicaid	$15.15
Rate for Payer: United Healthcare Medicare Advantage	$12.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.69
Rate for Payer: Wellcare Medicare	$10.90

LEAD INTERSTIM MRI INTERSTIM

Facility

$11,385.00

Service Code	HCPCS L8679
Hospital Charge Code	64907193
Hospital Revenue Code	278
Min. Negotiated Rate	$5,692.50
Max. Negotiated Rate	$5,692.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5,692.50

LEAD INTERSTIM MRI INTERSTIM

Facility

$11,385.00

Service Code	HCPCS L8679
Hospital Charge Code	64907193
Hospital Revenue Code	278
Min. Negotiated Rate	$3,984.75
Max. Negotiated Rate	$11,954.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,261.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,278.49
Rate for Payer: Aetna Government	$4,278.49
Rate for Payer: Brighton Health Commercial	$6,831.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,692.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,546.38
Rate for Payer: EmblemHealth Commercial	$5,692.50
Rate for Payer: Fidelis Medicare Advantage	$11,954.25
Rate for Payer: Group Health Inc Commercial	$5,692.50
Rate for Payer: Group Health Inc Medicare	$3,984.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,692.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5,692.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,400.25

LEAD, NEUROSTIM

Facility

$6,570.00

Service Code	HCPCS C1778
Hospital Charge Code	40203157
Hospital Revenue Code	278
Min. Negotiated Rate	$3,285.00
Max. Negotiated Rate	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00

LEAD, NEUROSTIM

Facility

$6,570.00

Service Code	HCPCS C1778
Hospital Charge Code	40203157
Hospital Revenue Code	278
Min. Negotiated Rate	$550.66
Max. Negotiated Rate	$6,898.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,613.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.66
Rate for Payer: Aetna Government	$550.66
Rate for Payer: Brighton Health Commercial	$3,942.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,285.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,777.75
Rate for Payer: EmblemHealth Commercial	$3,285.00
Rate for Payer: Fidelis Medicare Advantage	$6,898.50
Rate for Payer: Group Health Inc Commercial	$3,285.00
Rate for Payer: Group Health Inc Medicare	$2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,270.50

LEAD PACE TRNASV URE BIP STEROID

Facility

$1,125.00

Service Code	HCPCS C1777
Hospital Charge Code	64907339
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50

LEAD PACE TRNASV URE BIP STEROID

Facility

$1,125.00

Service Code	HCPCS C1777
Hospital Charge Code	64907339
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$1,181.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$562.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$646.88
Rate for Payer: EmblemHealth Commercial	$562.50
Rate for Payer: Fidelis Medicare Advantage	$1,181.25
Rate for Payer: Group Health Inc Commercial	$562.50
Rate for Payer: Group Health Inc Medicare	$393.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$731.25

LEAD PACING IMPLTBLE BI 6FR 52

Facility

$1,715.00

Service Code	HCPCS C1778
Hospital Charge Code	64901156
Hospital Revenue Code	278
Min. Negotiated Rate	$550.66
Max. Negotiated Rate	$1,800.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$943.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.66
Rate for Payer: Aetna Government	$550.66
Rate for Payer: Brighton Health Commercial	$1,029.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$857.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$986.12
Rate for Payer: EmblemHealth Commercial	$857.50
Rate for Payer: Fidelis Medicare Advantage	$1,800.75
Rate for Payer: Group Health Inc Commercial	$857.50
Rate for Payer: Group Health Inc Medicare	$600.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$857.50
Rate for Payer: Hamaspik Choice Inc Medicare	$857.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,114.75

LEAD PACING IMPLTBLE BI 6FR 52

Facility

$1,715.00

Service Code	HCPCS C1778
Hospital Charge Code	64901156
Hospital Revenue Code	278
Min. Negotiated Rate	$857.50
Max. Negotiated Rate	$857.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$857.50
Rate for Payer: Hamaspik Choice Inc Medicare	$857.50

LEAD PACING IMPLTBLE BI 6FR 58

Facility

$1,715.00

Service Code	HCPCS C1778
Hospital Charge Code	64901094
Hospital Revenue Code	278
Min. Negotiated Rate	$550.66
Max. Negotiated Rate	$1,800.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$943.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.66
Rate for Payer: Aetna Government	$550.66
Rate for Payer: Brighton Health Commercial	$1,029.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$857.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$986.12
Rate for Payer: EmblemHealth Commercial	$857.50
Rate for Payer: Fidelis Medicare Advantage	$1,800.75
Rate for Payer: Group Health Inc Commercial	$857.50
Rate for Payer: Group Health Inc Medicare	$600.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$857.50
Rate for Payer: Hamaspik Choice Inc Medicare	$857.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,114.75

LEAD PACING IMPLTBLE BI 6FR 58

Facility

$1,715.00

Service Code	HCPCS C1778
Hospital Charge Code	64901094
Hospital Revenue Code	278
Min. Negotiated Rate	$857.50
Max. Negotiated Rate	$857.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$857.50
Rate for Payer: Hamaspik Choice Inc Medicare	$857.50

LEAD PACING PERM QUADPOL 9FR135MM

Facility

$1,975.00

Service Code	HCPCS C1778
Hospital Charge Code	64901849
Hospital Revenue Code	278
Min. Negotiated Rate	$987.50
Max. Negotiated Rate	$987.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$987.50

LEAD PACING PERM QUADPOL 9FR135MM

Facility

$1,975.00

Service Code	HCPCS C1778
Hospital Charge Code	64901849
Hospital Revenue Code	278
Min. Negotiated Rate	$550.66
Max. Negotiated Rate	$2,073.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,086.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.66
Rate for Payer: Aetna Government	$550.66
Rate for Payer: Brighton Health Commercial	$1,185.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$987.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,135.62
Rate for Payer: EmblemHealth Commercial	$987.50
Rate for Payer: Fidelis Medicare Advantage	$2,073.75
Rate for Payer: Group Health Inc Commercial	$987.50
Rate for Payer: Group Health Inc Medicare	$691.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$987.50
Rate for Payer: Hamaspik Choice Inc Medicare	$987.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,283.75

LEAD PLEXA PROMRI

Facility

$8,875.00

Service Code	HCPCS C1777
Hospital Charge Code	64907357
Hospital Revenue Code	278
Min. Negotiated Rate	$4,437.50
Max. Negotiated Rate	$4,437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,437.50

LEAD PLEXA PROMRI

Facility

$8,875.00

Service Code	HCPCS C1777
Hospital Charge Code	64907357
Hospital Revenue Code	278
Min. Negotiated Rate	$988.18
Max. Negotiated Rate	$9,318.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,881.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$988.18
Rate for Payer: Aetna Government	$988.18
Rate for Payer: Brighton Health Commercial	$5,325.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,103.12
Rate for Payer: EmblemHealth Commercial	$4,437.50
Rate for Payer: Fidelis Medicare Advantage	$9,318.75
Rate for Payer: Group Health Inc Commercial	$4,437.50
Rate for Payer: Group Health Inc Medicare	$3,106.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,768.75

LEAD QUICK PACE

Facility

$104.76

Hospital Charge Code	64902575
Hospital Revenue Code	270
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$83.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.38
Rate for Payer: Aetna Government	$52.38
Rate for Payer: Brighton Health Commercial	$78.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$83.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.24
Rate for Payer: Group Health Inc Commercial	$52.38
Rate for Payer: Group Health Inc Medicare	$36.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.38
Rate for Payer: Hamaspik Choice Inc Medicare	$52.38

LEADS EKG 5/SET 29 MULTILNK GRABR

Facility

$34.07

Hospital Charge Code	64903282
Hospital Revenue Code	270
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$27.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.04
Rate for Payer: Aetna Government	$17.04
Rate for Payer: Brighton Health Commercial	$25.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.17
Rate for Payer: Group Health Inc Commercial	$17.04
Rate for Payer: Group Health Inc Medicare	$11.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.04
Rate for Payer: Hamaspik Choice Inc Medicare	$17.04

LEAD SOLIA MRI PRO 45

Facility

$3,990.00

Service Code	HCPCS C1876
Hospital Charge Code	64906875
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$4,189.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,194.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$2,394.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,995.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,294.25
Rate for Payer: EmblemHealth Commercial	$1,995.00
Rate for Payer: Fidelis Medicare Advantage	$4,189.50
Rate for Payer: Group Health Inc Commercial	$1,995.00
Rate for Payer: Group Health Inc Medicare	$1,396.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,995.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,593.50

LEAD SOLIA MRI PRO 45

Facility

$3,990.00

Service Code	HCPCS C1876
Hospital Charge Code	64906875
Hospital Revenue Code	278
Min. Negotiated Rate	$1,995.00
Max. Negotiated Rate	$1,995.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,995.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,995.00

Know your out-of-pocket cost for care.

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