St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MAXILLA FX-CLOSED REDUCT (TEETH I

Facility

$1,087.50

Service Code	HCPCS D7620
Hospital Charge Code	42301865
Hospital Revenue Code	361
Min. Negotiated Rate	$380.62
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$598.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$902.02
Rate for Payer: Aetna Government	$902.02
Rate for Payer: Brighton Health Commercial	$815.62
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: Group Health Inc Commercial	$543.75
Rate for Payer: Group Health Inc Medicare	$380.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$543.75
Rate for Payer: Hamaspik Choice Inc Medicare	$543.75

MAXILLA FX-OPEN REDUCTION (TEETH

Facility

$2,900.00

Service Code	HCPCS D7610
Hospital Charge Code	42301860
Hospital Revenue Code	361
Min. Negotiated Rate	$1,015.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,595.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,202.70
Rate for Payer: Aetna Government	$1,202.70
Rate for Payer: Brighton Health Commercial	$2,175.00
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: Group Health Inc Commercial	$1,450.00
Rate for Payer: Group Health Inc Medicare	$1,015.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,450.00

MAXILLARY SINUSOTOMY FOR REM TOOT

Facility

$1,087.50

Service Code	HCPCS D7560
Hospital Charge Code	42301855
Hospital Revenue Code	361
Min. Negotiated Rate	$380.62
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$598.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$743.62
Rate for Payer: Aetna Government	$743.62
Rate for Payer: Brighton Health Commercial	$815.62
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: Group Health Inc Commercial	$543.75
Rate for Payer: Group Health Inc Medicare	$380.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$543.75
Rate for Payer: Hamaspik Choice Inc Medicare	$543.75

MAX PARTIAL DENTURE/FLEXIBLE BASE

Facility

$1,400.00

Service Code	HCPCS D5225
Hospital Charge Code	42300738
Hospital Revenue Code	361
Min. Negotiated Rate	$285.71
Max. Negotiated Rate	$28,571.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$770.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.83
Rate for Payer: Aetna Government	$339.83
Rate for Payer: Affinity Essential Plan 1&2	$642.85
Rate for Payer: Affinity Essential Plan 3&4	$642.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$285.71
Rate for Payer: Amida Care Medicaid	$285.71
Rate for Payer: Brighton Health Commercial	$1,050.00
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: Fidelis CHP/HARP/Medicaid	$28,571.00
Rate for Payer: Fidelis Essential Plan Aliesa	$285.71
Rate for Payer: Fidelis Essential Plan QHP	$285.71
Rate for Payer: Fidelis Qualified Health Plan	$300.00
Rate for Payer: Group Health Inc Commercial	$700.00
Rate for Payer: Group Health Inc Medicare	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$285.71
Rate for Payer: Hamaspik Choice Inc Medicare	$700.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$285.71
Rate for Payer: Healthfirst Essential Plan	$642.85
Rate for Payer: Healthfirst QHP	$285.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$285.71
Rate for Payer: SOMOS Essential	$642.85
Rate for Payer: United Healthcare Essential Plan 1&2	$642.85
Rate for Payer: United Healthcare Essential Plan 3&4	$314.28
Rate for Payer: United Healthcare Medicaid	$285.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$285.71

MAX VOL VENT

Facility

$166.60

Service Code	HCPCS 94200 TC
Hospital Charge Code	40402707
Hospital Revenue Code	460
Min. Negotiated Rate	$49.52
Max. Negotiated Rate	$133.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$91.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.74
Rate for Payer: Aetna Government	$70.74
Rate for Payer: Affinity Essential Plan 1&2	$49.52
Rate for Payer: Affinity Essential Plan 3&4	$49.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$49.52
Rate for Payer: Brighton Health Commercial	$124.95
Rate for Payer: Cash Price	$70.74
Rate for Payer: Cash Price	$70.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$70.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.29
Rate for Payer: Elderplan Medicare Advantage	$70.74
Rate for Payer: EmblemHealth Commercial	$70.74
Rate for Payer: Fidelis Essential Plan Aliesa	$60.13
Rate for Payer: Fidelis Essential Plan QHP	$62.96
Rate for Payer: Fidelis Medicare Advantage	$70.74
Rate for Payer: Fidelis Qualified Health Plan	$62.96
Rate for Payer: Group Health Inc Commercial	$70.74
Rate for Payer: Group Health Inc Medicare	$70.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$83.30
Rate for Payer: Hamaspik Choice Inc Medicare	$70.74
Rate for Payer: Healthfirst Medicare Advantage	$60.13
Rate for Payer: Healthfirst QHP	$70.74
Rate for Payer: Humana Medicare	$72.15
Rate for Payer: Senior Whole Health Medicare Advantage	$70.74
Rate for Payer: United Healthcare Commercial	$83.30
Rate for Payer: United Healthcare Medicare Advantage	$70.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56.59
Rate for Payer: Wellcare Medicare	$67.20

MAX VOL VENT

Facility

$166.60

Service Code	HCPCS 94200 TC
Hospital Charge Code	40402707
Hospital Revenue Code	460
Rate for Payer: Cash Price	$70.74

MBS

Facility

$270.23

Service Code	HCPCS 92611
Hospital Charge Code	41904810
Hospital Revenue Code	444
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$222.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.42
Rate for Payer: Aetna Government	$75.42
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Group Health Inc Commercial	$135.12
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.12
Rate for Payer: Hamaspik Choice Inc Medicare	$135.12
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: Wellcare Medicare	$55.00

MC-3 BED

Facility

$124.04

Hospital Charge Code	40209231
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

MCB-PH GRAPHIC CASE,MODINSTR

Facility

$1,119.82

Hospital Charge Code	40006834
Hospital Revenue Code	272
Min. Negotiated Rate	$391.94
Max. Negotiated Rate	$895.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$615.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$559.91
Rate for Payer: Aetna Government	$559.91
Rate for Payer: Brighton Health Commercial	$839.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$895.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$761.48
Rate for Payer: Group Health Inc Commercial	$559.91
Rate for Payer: Group Health Inc Medicare	$391.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.91
Rate for Payer: Hamaspik Choice Inc Medicare	$559.91

MCB PP DIST FEM MIS BTM COV 18 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006812
Hospital Revenue Code	278
Min. Negotiated Rate	$211.36
Max. Negotiated Rate	$211.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36

MCB PP DIST FEM MIS BTM COV 18 HL

Facility

$422.72

Service Code	HCPCS C1713
Hospital Charge Code	40006812
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$443.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$232.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$253.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$243.06
Rate for Payer: EmblemHealth Commercial	$211.36
Rate for Payer: Fidelis Medicare Advantage	$443.86
Rate for Payer: Group Health Inc Commercial	$211.36
Rate for Payer: Group Health Inc Medicare	$147.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.36
Rate for Payer: Hamaspik Choice Inc Medicare	$211.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.77

MCB PP PF PROV,LT,15/18 HL PLATES

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006792
Hospital Revenue Code	278
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$202.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$106.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$115.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.87
Rate for Payer: EmblemHealth Commercial	$96.41
Rate for Payer: Fidelis Medicare Advantage	$202.46
Rate for Payer: Group Health Inc Commercial	$96.41
Rate for Payer: Group Health Inc Medicare	$67.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.33

MCB PP PF PROV,LT,15/18 HL PLATES

Facility

$192.82

Service Code	HCPCS C1713
Hospital Charge Code	40006792
Hospital Revenue Code	278
Min. Negotiated Rate	$96.41
Max. Negotiated Rate	$96.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.41
Rate for Payer: Hamaspik Choice Inc Medicare	$96.41

MCBRIDE BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28292
Hospital Charge Code	40021545
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

MCBRIDE BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28292
Hospital Charge Code	40021545
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

MCB SCREW 5.0X38MM SELF-TAPPING

Facility

$333.72

Service Code	HCPCS C1713
Hospital Charge Code	40006880
Hospital Revenue Code	278
Min. Negotiated Rate	$116.80
Max. Negotiated Rate	$350.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$183.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$200.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$166.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$191.89
Rate for Payer: EmblemHealth Commercial	$166.86
Rate for Payer: Fidelis Medicare Advantage	$350.41
Rate for Payer: Group Health Inc Commercial	$166.86
Rate for Payer: Group Health Inc Medicare	$116.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.86
Rate for Payer: Hamaspik Choice Inc Medicare	$166.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$216.92

MCB SCREW 5.0X38MM SELF-TAPPING

Facility

$333.72

Service Code	HCPCS C1713
Hospital Charge Code	40006880
Hospital Revenue Code	278
Min. Negotiated Rate	$166.86
Max. Negotiated Rate	$166.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$166.86
Rate for Payer: Hamaspik Choice Inc Medicare	$166.86

MCCD, RISK ADJ HI, INITIAL

Facility

$0.01

Service Code	HCPCS G9003
Hospital Charge Code	30306437
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

MDLNE TUBIN INSUFFLATIN W/ROT CN

Facility

$3.90

Hospital Charge Code	40201459
Hospital Revenue Code	270
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95

MD MORE THAN 1HR ASSIST NONRAD MD

Facility

$705.83

Service Code	HCPCS 76000 TC
Hospital Charge Code	66541307
Hospital Revenue Code	320
Rate for Payer: Cash Price	$283.37

MD MORE THAN 1HR ASSIST NONRAD MD

Facility

$705.83

Service Code	HCPCS 76000 TC
Hospital Charge Code	66541307
Hospital Revenue Code	320
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$388.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.40
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$198.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$240.86
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$255.03
Rate for Payer: Group Health Inc Medicare	$255.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$255.03
Rate for Payer: Healthfirst Medicare Advantage	$283.37
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

MEASLES-MUMPS-RUBELLA (MMR) VACCINE INJ

Facility

$102.95

Service Code	HCPCS 90707
Hospital Charge Code	41642425
Hospital Revenue Code	636
Min. Negotiated Rate	$51.48
Max. Negotiated Rate	$51.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.48
Rate for Payer: Hamaspik Choice Inc Medicare	$51.48

MEASLES-MUMPS-RUBELLA (MMR) VACCINE INJ

Facility

$102.95

Service Code	HCPCS 90707
Hospital Charge Code	41642425
Hospital Revenue Code	636
Min. Negotiated Rate	$36.03
Max. Negotiated Rate	$89.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.72
Rate for Payer: Aetna Government	$89.72
Rate for Payer: Brighton Health Commercial	$61.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.20
Rate for Payer: Group Health Inc Commercial	$51.48
Rate for Payer: Group Health Inc Medicare	$36.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.48
Rate for Payer: Hamaspik Choice Inc Medicare	$51.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.92

MEASLES-MUMPS-RUBELLA (MMR) VACCINE INJ

Facility

$102.95

Service Code	HCPCS 90707
Hospital Charge Code	41652425
Hospital Revenue Code	636
Min. Negotiated Rate	$51.48
Max. Negotiated Rate	$51.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.48
Rate for Payer: Hamaspik Choice Inc Medicare	$51.48

MEASLES-MUMPS-RUBELLA (MMR) VACCINE INJ

Facility

$102.95

Service Code	HCPCS 90707
Hospital Charge Code	41652425
Hospital Revenue Code	636
Min. Negotiated Rate	$36.03
Max. Negotiated Rate	$89.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$89.72
Rate for Payer: Aetna Government	$89.72
Rate for Payer: Brighton Health Commercial	$61.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.20
Rate for Payer: Group Health Inc Commercial	$51.48
Rate for Payer: Group Health Inc Medicare	$36.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.48
Rate for Payer: Hamaspik Choice Inc Medicare	$51.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.92

Know your out-of-pocket cost for care.

All Charges