St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MICONAZOLE 2% VAGINAL CREAM

Facility

$5.16

Hospital Charge Code	41641264
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$4.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.58
Rate for Payer: Aetna Government	$2.58
Rate for Payer: Brighton Health Commercial	$3.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.51
Rate for Payer: Group Health Inc Commercial	$2.58
Rate for Payer: Group Health Inc Medicare	$1.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.58
Rate for Payer: Hamaspik Choice Inc Medicare	$2.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.35

MICONAZOLE NITRATE 2 % VA CREA [5040]

Facility

$0.16

Service Code	NDC 61269073041
Hospital Charge Code	61269073041
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
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	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
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	$0.10

MICONAZOLE NITRATE 2 % VA CREA [5040]

Facility

$0.26

Service Code	NDC 00904773445
Hospital Charge Code	00904773445
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

MICONAZOLE VAGINAL SUPPOSITORY 100 MG (

Facility

$1.00

Hospital Charge Code	41650320
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MICONAZOLE VAGINAL SUPPOSITORY 100 MG (

Facility

$1.00

Hospital Charge Code	41640320
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MICO OTOSCOPY

Facility

$84.43

Service Code	HCPCS 92504
Hospital Charge Code	30304099
Hospital Revenue Code	510
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.18
Rate for Payer: Aetna Government	$8.18
Rate for Payer: Brighton Health Commercial	$233.00
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	$42.22
Rate for Payer: Hamaspik Choice Inc Medicare	$42.22
Rate for Payer: United Healthcare Commercial	$222.00

MICRO 4H PLATE

Facility

$136.00

Service Code	HCPCS C1713
Hospital Charge Code	40200059
Hospital Revenue Code	278
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$68.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00

MICRO 4H PLATE

Facility

$136.00

Service Code	HCPCS C1713
Hospital Charge Code	40200059
Hospital Revenue Code	278
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$142.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$81.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.20
Rate for Payer: EmblemHealth Commercial	$68.00
Rate for Payer: Fidelis Medicare Advantage	$142.80
Rate for Payer: Group Health Inc Commercial	$68.00
Rate for Payer: Group Health Inc Medicare	$47.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.40

MICROALBUMIN/CREATININE RATIO U

Facility

$14.45

Service Code	HCPCS 82043
Hospital Charge Code	40602601
Hospital Revenue Code	300
Rate for Payer: Cash Price	$5.78

MICROALBUMIN/CREATININE RATIO U

Facility

$14.45

Service Code	HCPCS 82043
Hospital Charge Code	40602601
Hospital Revenue Code	300
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$10.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.78
Rate for Payer: Aetna Government	$5.78
Rate for Payer: Affinity Essential Plan 1&2	$4.05
Rate for Payer: Affinity Essential Plan 3&4	$4.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.05
Rate for Payer: Brighton Health Commercial	$10.84
Rate for Payer: Cash Price	$5.78
Rate for Payer: Cash Price	$5.78
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.78
Rate for Payer: Elderplan Medicare Advantage	$5.78
Rate for Payer: EmblemHealth Commercial	$5.78
Rate for Payer: Fidelis Essential Plan Aliesa	$4.91
Rate for Payer: Fidelis Essential Plan QHP	$5.14
Rate for Payer: Fidelis Medicare Advantage	$5.78
Rate for Payer: Fidelis Qualified Health Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$5.78
Rate for Payer: Group Health Inc Medicare	$5.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.22
Rate for Payer: Hamaspik Choice Inc Medicare	$5.78
Rate for Payer: Healthfirst Medicare Advantage	$5.78
Rate for Payer: Healthfirst QHP	$5.78
Rate for Payer: Humana Medicare	$5.90
Rate for Payer: Senior Whole Health Medicare Advantage	$5.78
Rate for Payer: United Healthcare Commercial	$7.33
Rate for Payer: United Healthcare Medicare Advantage	$5.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.62
Rate for Payer: Wellcare Medicare	$5.20

MICROBE SUSCEPTIBLE DIFFUSE

Facility

$11.88

Service Code	HCPCS 87181
Hospital Charge Code	40614327
Hospital Revenue Code	300
Rate for Payer: Cash Price	$4.75

MICROBE SUSCEPTIBLE DIFFUSE

Facility

$11.88

Service Code	HCPCS 87181
Hospital Charge Code	40614327
Hospital Revenue Code	300
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$8.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.75
Rate for Payer: Aetna Government	$4.75
Rate for Payer: Affinity Essential Plan 1&2	$3.32
Rate for Payer: Affinity Essential Plan 3&4	$3.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.32
Rate for Payer: Brighton Health Commercial	$8.91
Rate for Payer: Cash Price	$4.75
Rate for Payer: Cash Price	$4.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.38
Rate for Payer: Elderplan Medicare Advantage	$4.75
Rate for Payer: EmblemHealth Commercial	$4.75
Rate for Payer: Fidelis Essential Plan Aliesa	$4.04
Rate for Payer: Fidelis Essential Plan QHP	$4.23
Rate for Payer: Fidelis Medicare Advantage	$4.75
Rate for Payer: Fidelis Qualified Health Plan	$4.23
Rate for Payer: Group Health Inc Commercial	$4.75
Rate for Payer: Group Health Inc Medicare	$4.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4.75
Rate for Payer: Healthfirst Medicare Advantage	$4.75
Rate for Payer: Healthfirst QHP	$4.75
Rate for Payer: Humana Medicare	$4.84
Rate for Payer: Senior Whole Health Medicare Advantage	$4.75
Rate for Payer: United Healthcare Commercial	$6.01
Rate for Payer: United Healthcare Medicare Advantage	$4.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.80
Rate for Payer: Wellcare Medicare	$4.28

MICROBE SUSCEPTIBLE DISK

Facility

$18.70

Service Code	HCPCS 87184
Hospital Charge Code	40614328
Hospital Revenue Code	300
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$14.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.48
Rate for Payer: Aetna Government	$7.48
Rate for Payer: Affinity Essential Plan 1&2	$5.24
Rate for Payer: Affinity Essential Plan 3&4	$5.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$5.24
Rate for Payer: Brighton Health Commercial	$14.02
Rate for Payer: Cash Price	$7.48
Rate for Payer: Cash Price	$7.48
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.27
Rate for Payer: Elderplan Medicare Advantage	$7.48
Rate for Payer: EmblemHealth Commercial	$7.48
Rate for Payer: Fidelis Essential Plan Aliesa	$6.36
Rate for Payer: Fidelis Essential Plan QHP	$6.66
Rate for Payer: Fidelis Medicare Advantage	$7.48
Rate for Payer: Fidelis Qualified Health Plan	$6.66
Rate for Payer: Group Health Inc Commercial	$7.48
Rate for Payer: Group Health Inc Medicare	$7.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.35
Rate for Payer: Hamaspik Choice Inc Medicare	$7.48
Rate for Payer: Healthfirst Medicare Advantage	$7.48
Rate for Payer: Healthfirst QHP	$7.48
Rate for Payer: Humana Medicare	$7.63
Rate for Payer: Senior Whole Health Medicare Advantage	$7.48
Rate for Payer: United Healthcare Commercial	$8.74
Rate for Payer: United Healthcare Medicare Advantage	$7.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.98
Rate for Payer: Wellcare Medicare	$6.73

MICROBE SUSCEPTIBLE DISK

Facility

$18.70

Service Code	HCPCS 87184
Hospital Charge Code	40614328
Hospital Revenue Code	300
Rate for Payer: Cash Price	$7.48

MICROBE SUSCEPTIBLE ENZYME

Facility

$11.88

Service Code	HCPCS 87185
Hospital Charge Code	40614329
Hospital Revenue Code	300
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$8.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.75
Rate for Payer: Aetna Government	$4.75
Rate for Payer: Affinity Essential Plan 1&2	$3.32
Rate for Payer: Affinity Essential Plan 3&4	$3.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$3.32
Rate for Payer: Brighton Health Commercial	$8.91
Rate for Payer: Cash Price	$4.75
Rate for Payer: Cash Price	$4.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.38
Rate for Payer: Elderplan Medicare Advantage	$4.75
Rate for Payer: EmblemHealth Commercial	$4.75
Rate for Payer: Fidelis Essential Plan Aliesa	$4.04
Rate for Payer: Fidelis Essential Plan QHP	$4.23
Rate for Payer: Fidelis Medicare Advantage	$4.75
Rate for Payer: Fidelis Qualified Health Plan	$4.23
Rate for Payer: Group Health Inc Commercial	$4.75
Rate for Payer: Group Health Inc Medicare	$4.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.94
Rate for Payer: Hamaspik Choice Inc Medicare	$4.75
Rate for Payer: Healthfirst Medicare Advantage	$4.75
Rate for Payer: Healthfirst QHP	$4.75
Rate for Payer: Humana Medicare	$4.84
Rate for Payer: Senior Whole Health Medicare Advantage	$4.75
Rate for Payer: United Healthcare Commercial	$6.01
Rate for Payer: United Healthcare Medicare Advantage	$4.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.80
Rate for Payer: Wellcare Medicare	$4.28

MICROBE SUSCEPTIBLE ENZYME

Facility

$11.88

Service Code	HCPCS 87185
Hospital Charge Code	40614329
Hospital Revenue Code	300
Rate for Payer: Cash Price	$4.75

MICROBE SUSCEPTIBLE MIC

Facility

$21.63

Service Code	HCPCS 87186
Hospital Charge Code	40614330
Hospital Revenue Code	300
Rate for Payer: Cash Price	$8.65

MICROBE SUSCEPTIBLE MIC

Facility

$21.63

Service Code	HCPCS 87186
Hospital Charge Code	40614330
Hospital Revenue Code	300
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$16.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.65
Rate for Payer: Aetna Government	$8.65
Rate for Payer: Affinity Essential Plan 1&2	$6.06
Rate for Payer: Affinity Essential Plan 3&4	$6.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.06
Rate for Payer: Brighton Health Commercial	$16.22
Rate for Payer: Cash Price	$8.65
Rate for Payer: Cash Price	$8.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.63
Rate for Payer: Elderplan Medicare Advantage	$8.65
Rate for Payer: EmblemHealth Commercial	$8.65
Rate for Payer: Fidelis Essential Plan Aliesa	$7.35
Rate for Payer: Fidelis Essential Plan QHP	$7.70
Rate for Payer: Fidelis Medicare Advantage	$8.65
Rate for Payer: Fidelis Qualified Health Plan	$7.70
Rate for Payer: Group Health Inc Commercial	$8.65
Rate for Payer: Group Health Inc Medicare	$8.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.82
Rate for Payer: Hamaspik Choice Inc Medicare	$8.65
Rate for Payer: Healthfirst Medicare Advantage	$8.65
Rate for Payer: Healthfirst QHP	$8.65
Rate for Payer: Humana Medicare	$8.82
Rate for Payer: Senior Whole Health Medicare Advantage	$8.65
Rate for Payer: United Healthcare Commercial	$10.95
Rate for Payer: United Healthcare Medicare Advantage	$8.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.92
Rate for Payer: Wellcare Medicare	$7.78

MICRO CANNULATED SCRW 3.0 14MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	40201227
Hospital Revenue Code	278
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00

MICRO CANNULATED SCRW 3.0 14MM

Facility

$32.00

Service Code	HCPCS C1713
Hospital Charge Code	40201227
Hospital Revenue Code	278
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$19.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.40
Rate for Payer: EmblemHealth Commercial	$16.00
Rate for Payer: Fidelis Medicare Advantage	$33.60
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.80

MICRODEBRIEDER TOPAZ

Facility

$548.00

Hospital Charge Code	64906243
Hospital Revenue Code	270
Min. Negotiated Rate	$191.80
Max. Negotiated Rate	$438.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$301.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$274.00
Rate for Payer: Aetna Government	$274.00
Rate for Payer: Brighton Health Commercial	$411.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$438.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$372.64
Rate for Payer: Group Health Inc Commercial	$274.00
Rate for Payer: Group Health Inc Medicare	$191.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.00
Rate for Payer: Hamaspik Choice Inc Medicare	$274.00

MICROMATRIX 500MG

Facility

$3,255.40

Service Code	HCPCS Q4166
Hospital Charge Code	64907440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,627.70
Max. Negotiated Rate	$1,627.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,627.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,627.70

MICROMATRIX 500MG

Facility

$3,255.40

Service Code	HCPCS Q4166
Hospital Charge Code	64907440
Hospital Revenue Code	278
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$3,418.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,790.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.89
Rate for Payer: Aetna Government	$15.89
Rate for Payer: Brighton Health Commercial	$1,953.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,627.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,871.86
Rate for Payer: EmblemHealth Commercial	$1,627.70
Rate for Payer: Fidelis Medicare Advantage	$3,418.17
Rate for Payer: Group Health Inc Commercial	$1,627.70
Rate for Payer: Group Health Inc Medicare	$1,139.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,627.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,627.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,116.01

MICRO PLATE L-SHAPE LEFT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209904
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

MICRO PLATE L-SHAPE LEFT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40209904
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

Know your out-of-pocket cost for care.

All Charges