St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MEROPENEM 500 MG IV SOLR [17379]

Facility

$7.20

Service Code	HCPCS J2185
Hospital Charge Code	55150020720
Hospital Revenue Code	278
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$7.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$4.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.14
Rate for Payer: EmblemHealth Commercial	$3.60
Rate for Payer: Fidelis Medicare Advantage	$7.56
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

MEROPENEM 500 MG IV SOLR [17379]

Facility

$12.36

Service Code	HCPCS J2185
Hospital Charge Code	00409139021
Hospital Revenue Code	278
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$6.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.18
Rate for Payer: Hamaspik Choice Inc Medicare	$6.18

MEROPENEM 500 MG IV SOLR [17379]

Facility

$12.36

Service Code	HCPCS J2185
Hospital Charge Code	00409139021
Hospital Revenue Code	278
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$12.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$7.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.11
Rate for Payer: EmblemHealth Commercial	$6.18
Rate for Payer: Fidelis Medicare Advantage	$12.98
Rate for Payer: Group Health Inc Commercial	$6.18
Rate for Payer: Group Health Inc Medicare	$4.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.18
Rate for Payer: Hamaspik Choice Inc Medicare	$6.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.03

MEROPENEM/VABORBACTAM

Facility

$4.43

Service Code	HCPCS J2186
Hospital Charge Code	41650348
Hospital Revenue Code	636
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Cash Price	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2.22

MEROPENEM/VABORBACTAM

Facility

$4.43

Service Code	HCPCS J2186
Hospital Charge Code	41640348
Hospital Revenue Code	636
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Cash Price	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2.22

MEROPENEM/VABORBACTAM

Facility

$4.43

Service Code	HCPCS J2186
Hospital Charge Code	41650348
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.08
Rate for Payer: Aetna Government	$2.08
Rate for Payer: Affinity Essential Plan 1&2	$1.45
Rate for Payer: Affinity Essential Plan 3&4	$1.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.45
Rate for Payer: Brighton Health Commercial	$2.66
Rate for Payer: Cash Price	$2.08
Rate for Payer: Cash Price	$2.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.55
Rate for Payer: Elderplan Medicare Advantage	$2.08
Rate for Payer: EmblemHealth Commercial	$2.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.08
Rate for Payer: Fidelis Essential Plan Aliesa	$2.08
Rate for Payer: Fidelis Essential Plan QHP	$2.18
Rate for Payer: Fidelis Medicare Advantage	$2.08
Rate for Payer: Fidelis Qualified Health Plan	$2.18
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2.22
Rate for Payer: Healthfirst Medicare Advantage	$1.76
Rate for Payer: Healthfirst QHP	$2.08
Rate for Payer: Humana Medicare	$2.12
Rate for Payer: Senior Whole Health Medicare Advantage	$2.08
Rate for Payer: United Healthcare Commercial	$1.99
Rate for Payer: United Healthcare Medicare Advantage	$2.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.66
Rate for Payer: Wellcare Medicare	$1.97

MEROPENEM/VABORBACTAM

Facility

$4.43

Service Code	HCPCS J2186
Hospital Charge Code	41640348
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.08
Rate for Payer: Aetna Government	$2.08
Rate for Payer: Affinity Essential Plan 1&2	$1.45
Rate for Payer: Affinity Essential Plan 3&4	$1.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.45
Rate for Payer: Brighton Health Commercial	$2.66
Rate for Payer: Cash Price	$2.08
Rate for Payer: Cash Price	$2.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.55
Rate for Payer: Elderplan Medicare Advantage	$2.08
Rate for Payer: EmblemHealth Commercial	$2.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.08
Rate for Payer: Fidelis Essential Plan Aliesa	$2.08
Rate for Payer: Fidelis Essential Plan QHP	$2.18
Rate for Payer: Fidelis Medicare Advantage	$2.08
Rate for Payer: Fidelis Qualified Health Plan	$2.18
Rate for Payer: Group Health Inc Commercial	$2.08
Rate for Payer: Group Health Inc Medicare	$2.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.22
Rate for Payer: Hamaspik Choice Inc Medicare	$2.22
Rate for Payer: Healthfirst Medicare Advantage	$1.76
Rate for Payer: Healthfirst QHP	$2.08
Rate for Payer: Humana Medicare	$2.12
Rate for Payer: Senior Whole Health Medicare Advantage	$2.08
Rate for Payer: United Healthcare Commercial	$1.99
Rate for Payer: United Healthcare Medicare Advantage	$2.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.66
Rate for Payer: Wellcare Medicare	$1.97

MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR [146229]

Facility

$259.20

Service Code	HCPCS J3490
Hospital Charge Code	70842012006
Hospital Revenue Code	278
Min. Negotiated Rate	$90.72
Max. Negotiated Rate	$272.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$129.60
Rate for Payer: Aetna Government	$129.60
Rate for Payer: Brighton Health Commercial	$155.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.04
Rate for Payer: EmblemHealth Commercial	$129.60
Rate for Payer: Fidelis Medicare Advantage	$272.16
Rate for Payer: Group Health Inc Commercial	$129.60
Rate for Payer: Group Health Inc Medicare	$90.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.60
Rate for Payer: Hamaspik Choice Inc Medicare	$129.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.48

MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR [146229]

Facility

$259.20

Service Code	HCPCS J3490
Hospital Charge Code	70842012006
Hospital Revenue Code	278
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$129.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.60
Rate for Payer: Hamaspik Choice Inc Medicare	$129.60

MESALAMINE 250MG CAP

Facility

$5.33

Hospital Charge Code	41656588
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Brighton Health Commercial	$4.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.62
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.46

MESALAMINE 250MG CAP

Facility

$5.33

Hospital Charge Code	41646588
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.66
Rate for Payer: Aetna Government	$2.66
Rate for Payer: Brighton Health Commercial	$4.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.62
Rate for Payer: Group Health Inc Commercial	$2.66
Rate for Payer: Group Health Inc Medicare	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.66
Rate for Payer: Hamaspik Choice Inc Medicare	$2.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.46

MESALAMINE 400 MG TAB EC

Facility

$3.87

Hospital Charge Code	41644084
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.94
Rate for Payer: Aetna Government	$1.94
Rate for Payer: Brighton Health Commercial	$2.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.63
Rate for Payer: Group Health Inc Commercial	$1.94
Rate for Payer: Group Health Inc Medicare	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.52

MESALAMINE 400 MG TAB EC

Facility

$3.87

Hospital Charge Code	41654084
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.94
Rate for Payer: Aetna Government	$1.94
Rate for Payer: Brighton Health Commercial	$2.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.63
Rate for Payer: Group Health Inc Commercial	$1.94
Rate for Payer: Group Health Inc Medicare	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.52

MESALAMINE 4 GRAMS/60 ML RECTAL SUSP

Facility

$13.00

Hospital Charge Code	41653811
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

MESALAMINE 4 GRAMS/60 ML RECTAL SUSP

Facility

$13.00

Hospital Charge Code	41643811
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.50
Rate for Payer: Aetna Government	$6.50
Rate for Payer: Brighton Health Commercial	$9.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.84
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.45

MESALAMINE 4 G RE ENEM [10535]

Facility

$0.41

Service Code	NDC 45802009851
Hospital Charge Code	45802009851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

MESALAMINE 4 G RE ENEM [10535]

Facility

$0.39

Service Code	NDC 45802009828
Hospital Charge Code	45802009828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

MESALAMINE 800MG DR TAB

Facility

$4.09

Hospital Charge Code	41648416
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

MESALAMINE 800MG DR TAB

Facility

$4.09

Hospital Charge Code	41658416
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.04
Rate for Payer: Aetna Government	$2.04
Rate for Payer: Brighton Health Commercial	$3.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.78
Rate for Payer: Group Health Inc Commercial	$2.04
Rate for Payer: Group Health Inc Medicare	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.04
Rate for Payer: Hamaspik Choice Inc Medicare	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.66

MESALAMINE 800 MG PO TBEC [96949]

Facility

$9.27

Service Code	NDC 68382043528
Hospital Charge Code	68382043528
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$7.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.64
Rate for Payer: Aetna Government	$4.64
Rate for Payer: Brighton Health Commercial	$6.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.31
Rate for Payer: Group Health Inc Commercial	$4.64
Rate for Payer: Group Health Inc Medicare	$3.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.64
Rate for Payer: Hamaspik Choice Inc Medicare	$4.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.03

MESH

Facility

$712.50

Service Code	HCPCS C1781
Hospital Charge Code	40203572
Hospital Revenue Code	278
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.25
Rate for Payer: Hamaspik Choice Inc Medicare	$356.25

MESH

Facility

$712.50

Service Code	HCPCS C1781
Hospital Charge Code	40203572
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$748.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$391.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$427.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$356.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$409.69
Rate for Payer: EmblemHealth Commercial	$356.25
Rate for Payer: Fidelis Medicare Advantage	$748.12
Rate for Payer: Group Health Inc Commercial	$356.25
Rate for Payer: Group Health Inc Medicare	$249.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.25
Rate for Payer: Hamaspik Choice Inc Medicare	$356.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$463.12

MESH > 1000

Facility

$3,892.25

Service Code	HCPCS C1781
Hospital Charge Code	40203063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,946.12
Max. Negotiated Rate	$1,946.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,946.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,946.12

MESH > 1000

Facility

$3,892.25

Service Code	HCPCS C1781
Hospital Charge Code	40203063
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$4,086.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,140.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$2,335.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,946.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,238.04
Rate for Payer: EmblemHealth Commercial	$1,946.12
Rate for Payer: Fidelis Medicare Advantage	$4,086.86
Rate for Payer: Group Health Inc Commercial	$1,946.12
Rate for Payer: Group Health Inc Medicare	$1,362.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,946.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,946.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,529.96

MESH 100-499

Facility

$630.28

Service Code	HCPCS C1781
Hospital Charge Code	40203061
Hospital Revenue Code	278
Min. Negotiated Rate	$315.14
Max. Negotiated Rate	$315.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$315.14
Rate for Payer: Hamaspik Choice Inc Medicare	$315.14

Know your out-of-pocket cost for care.

All Charges