St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MMD NAIL EXCISION

Facility

$100.00

Hospital Charge Code	46359034
Hospital Revenue Code	456
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD PHENERGAN (UP TO 50MG)

Facility

$25.00

Hospital Charge Code	46359012
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD POST OP SHOE

Facility

$35.00

Hospital Charge Code	46359057
Hospital Revenue Code	456
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.50
Rate for Payer: Aetna Government	$17.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD RAPID FLU

Facility

$25.00

Hospital Charge Code	46359022
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD RAPID SARS ANTIGEN

Facility

$25.00

Hospital Charge Code	46359024
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD RAPID STREP

Facility

$25.00

Hospital Charge Code	46359023
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD RIB BELT

Facility

$20.00

Hospital Charge Code	46359058
Hospital Revenue Code	456
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD ROCEPHIN 1G

Facility

$100.00

Hospital Charge Code	46359015
Hospital Revenue Code	456
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD ROCEPHIN 250MG

Facility

$50.00

Hospital Charge Code	46359013
Hospital Revenue Code	456
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD ROCEPHIN 500MG

Facility

$50.00

Hospital Charge Code	46359014
Hospital Revenue Code	456
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD SHORT ARM

Facility

$25.00

Hospital Charge Code	46359062
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD SHORT LEG

Facility

$25.00

Hospital Charge Code	46359064
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD SIMPLE

Facility

$125.00

Hospital Charge Code	46359036
Hospital Revenue Code	456
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.50
Rate for Payer: Aetna Government	$62.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50
Rate for Payer: Hamaspik Choice Inc Medicare	$62.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD SIMPLE (FB)

Facility

$100.00

Hospital Charge Code	46359028
Hospital Revenue Code	456
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.00
Rate for Payer: Aetna Government	$50.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD SOLUMEDROL UP TO 125MG

Facility

$25.00

Hospital Charge Code	46359016
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD SPORTS

Facility

$65.00

Hospital Charge Code	46359049
Hospital Revenue Code	456
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.50
Rate for Payer: Aetna Government	$32.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.50
Rate for Payer: Hamaspik Choice Inc Medicare	$32.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD SUTURE REMOVAL-ORIGINL SUTURE

Facility

$50.00

Hospital Charge Code	46359039
Hospital Revenue Code	456
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD TD (TETANUS & DIPHTHERIA)

Facility

$50.00

Hospital Charge Code	46359017
Hospital Revenue Code	456
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD THUMB SPICA/ULNAR GUTTER

Facility

$25.00

Hospital Charge Code	46359059
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD TORADOL 30MG

Facility

$25.00

Hospital Charge Code	46359018
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD TORADOL 60MG

Facility

$50.00

Hospital Charge Code	46359019
Hospital Revenue Code	456
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.00
Rate for Payer: Aetna Government	$25.00
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.00
Rate for Payer: Hamaspik Choice Inc Medicare	$25.00
Rate for Payer: United Healthcare Commercial	$50.00

MMD URINALYSIS DIPSTICK

Facility

$25.00

Hospital Charge Code	46359025
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD VENIPUNCTURE

Facility

$25.00

Hospital Charge Code	46359027
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD WRIST BRACE

Facility

$25.00

Hospital Charge Code	46359060
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

MMD WRIST/FOREARM

Facility

$25.00

Hospital Charge Code	46359061
Hospital Revenue Code	456
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.50
Rate for Payer: Aetna Government	$12.50
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$747.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$635.21
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: United Healthcare Commercial	$50.00

Know your out-of-pocket cost for care.

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