St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MP E.R SCREW C-PIN 2.3 X 14 MM

Facility

$131.18

Service Code	HCPCS C1713
Hospital Charge Code	40201251
Hospital Revenue Code	278
Min. Negotiated Rate	$65.59
Max. Negotiated Rate	$65.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.59
Rate for Payer: Hamaspik Choice Inc Medicare	$65.59

MP E.R SCREW C-PIN 2.3 X 16 MM

Facility

$131.18

Service Code	HCPCS C1713
Hospital Charge Code	40201252
Hospital Revenue Code	278
Min. Negotiated Rate	$65.59
Max. Negotiated Rate	$65.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.59
Rate for Payer: Hamaspik Choice Inc Medicare	$65.59

MP E.R SCREW C-PIN 2.3 X 16 MM

Facility

$131.18

Service Code	HCPCS C1713
Hospital Charge Code	40201252
Hospital Revenue Code	278
Min. Negotiated Rate	$45.91
Max. Negotiated Rate	$137.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$72.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.43
Rate for Payer: EmblemHealth Commercial	$65.59
Rate for Payer: Fidelis Medicare Advantage	$137.74
Rate for Payer: Group Health Inc Commercial	$65.59
Rate for Payer: Group Health Inc Medicare	$45.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.59
Rate for Payer: Hamaspik Choice Inc Medicare	$65.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$85.27

MP E.R SCREW C-PIN 2.3 X 6 MM

Facility

$118.00

Service Code	HCPCS C1713
Hospital Charge Code	40201253
Hospital Revenue Code	278
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$59.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.00
Rate for Payer: Hamaspik Choice Inc Medicare	$59.00

MP E.R SCREW C-PIN 2.3 X 6 MM

Facility

$118.00

Service Code	HCPCS C1713
Hospital Charge Code	40201253
Hospital Revenue Code	278
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$70.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.85
Rate for Payer: EmblemHealth Commercial	$59.00
Rate for Payer: Fidelis Medicare Advantage	$123.90
Rate for Payer: Group Health Inc Commercial	$59.00
Rate for Payer: Group Health Inc Medicare	$41.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.00
Rate for Payer: Hamaspik Choice Inc Medicare	$59.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.70

MP E.R SCREW C-PIN 2.3 X 8 MM

Facility

$118.00

Service Code	HCPCS C1713
Hospital Charge Code	40201254
Hospital Revenue Code	278
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$59.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.00
Rate for Payer: Hamaspik Choice Inc Medicare	$59.00

MP E.R SCREW C-PIN 2.3 X 8 MM

Facility

$118.00

Service Code	HCPCS C1713
Hospital Charge Code	40201254
Hospital Revenue Code	278
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$70.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$67.85
Rate for Payer: EmblemHealth Commercial	$59.00
Rate for Payer: Fidelis Medicare Advantage	$123.90
Rate for Payer: Group Health Inc Commercial	$59.00
Rate for Payer: Group Health Inc Medicare	$41.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.00
Rate for Payer: Hamaspik Choice Inc Medicare	$59.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$76.70

M. PNEUMONIAE AB, IGG/IGM, EIA

Facility

$33.10

Service Code	HCPCS 86738
Hospital Charge Code	40728105
Hospital Revenue Code	302
Rate for Payer: Cash Price	$13.24

M. PNEUMONIAE AB, IGG/IGM, EIA

Facility

$33.10

Service Code	HCPCS 86738
Hospital Charge Code	40728105
Hospital Revenue Code	302
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$24.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.24
Rate for Payer: Aetna Government	$13.24
Rate for Payer: Affinity Essential Plan 1&2	$9.27
Rate for Payer: Affinity Essential Plan 3&4	$9.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$9.27
Rate for Payer: Brighton Health Commercial	$24.82
Rate for Payer: Cash Price	$13.24
Rate for Payer: Cash Price	$13.24
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.82
Rate for Payer: Elderplan Medicare Advantage	$13.24
Rate for Payer: EmblemHealth Commercial	$13.24
Rate for Payer: Fidelis Essential Plan Aliesa	$11.25
Rate for Payer: Fidelis Essential Plan QHP	$11.78
Rate for Payer: Fidelis Medicare Advantage	$13.24
Rate for Payer: Fidelis Qualified Health Plan	$11.78
Rate for Payer: Group Health Inc Commercial	$13.24
Rate for Payer: Group Health Inc Medicare	$13.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.55
Rate for Payer: Hamaspik Choice Inc Medicare	$13.24
Rate for Payer: Healthfirst Medicare Advantage	$13.24
Rate for Payer: Healthfirst QHP	$13.24
Rate for Payer: Humana Medicare	$13.50
Rate for Payer: Senior Whole Health Medicare Advantage	$13.24
Rate for Payer: United Healthcare Commercial	$16.78
Rate for Payer: United Healthcare Medicare Advantage	$13.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.59
Rate for Payer: Wellcare Medicare	$11.92

MP PLATE 4 HOLE REINFORCED BAR

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	40201255
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$829.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$434.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$474.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$395.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$454.25
Rate for Payer: EmblemHealth Commercial	$395.00
Rate for Payer: Fidelis Medicare Advantage	$829.50
Rate for Payer: Group Health Inc Commercial	$395.00
Rate for Payer: Group Health Inc Medicare	$276.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$513.50

MP PLATE 4 HOLE REINFORCED BAR

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	40201255
Hospital Revenue Code	278
Min. Negotiated Rate	$395.00
Max. Negotiated Rate	$395.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00

MP PLT 4 HOLE REINFRCED BAR

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	40209740
Hospital Revenue Code	278
Min. Negotiated Rate	$395.00
Max. Negotiated Rate	$395.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00

MP PLT 4 HOLE REINFRCED BAR

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	40209740
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$829.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$434.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$474.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$395.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$454.25
Rate for Payer: EmblemHealth Commercial	$395.00
Rate for Payer: Fidelis Medicare Advantage	$829.50
Rate for Payer: Group Health Inc Commercial	$395.00
Rate for Payer: Group Health Inc Medicare	$276.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$513.50

MR 3D RENDERING WITH POST PROCESS

Facility

$1,132.90

Service Code	HCPCS 76377 TC
Hospital Charge Code	41561887
Hospital Revenue Code	350
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$906.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$623.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.94
Rate for Payer: Aetna Government	$32.94
Rate for Payer: Brighton Health Commercial	$849.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$906.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$770.37
Rate for Payer: Group Health Inc Commercial	$566.45
Rate for Payer: Group Health Inc Medicare	$396.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$566.45
Rate for Payer: Hamaspik Choice Inc Medicare	$566.45

MRA ABDOMEN

Facility

$1,374.83

Service Code	HCPCS 74185 TC
Hospital Charge Code	41403060
Hospital Revenue Code	619
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,031.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,031.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,030.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$871.55
Rate for Payer: Group Health Inc Commercial	$687.42
Rate for Payer: Group Health Inc Medicare	$481.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.42
Rate for Payer: Hamaspik Choice Inc Medicare	$687.42
Rate for Payer: United Healthcare Commercial	$295.18

MR ABDOMEN C+

Facility

$1,156.53

Service Code	HCPCS 74182 TC
Hospital Charge Code	41403004
Hospital Revenue Code	610
Min. Negotiated Rate	$311.31
Max. Negotiated Rate	$874.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$636.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$444.73
Rate for Payer: Aetna Government	$444.73
Rate for Payer: Affinity Essential Plan 1&2	$311.31
Rate for Payer: Affinity Essential Plan 3&4	$311.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$311.31
Rate for Payer: Brighton Health Commercial	$867.40
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cash Price	$444.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$444.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$874.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$740.04
Rate for Payer: Elderplan Medicare Advantage	$444.73
Rate for Payer: EmblemHealth Commercial	$311.31
Rate for Payer: Fidelis Essential Plan Aliesa	$378.02
Rate for Payer: Fidelis Essential Plan QHP	$395.81
Rate for Payer: Fidelis Medicare Advantage	$444.73
Rate for Payer: Fidelis Qualified Health Plan	$395.81
Rate for Payer: Group Health Inc Commercial	$400.26
Rate for Payer: Group Health Inc Medicare	$400.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.26
Rate for Payer: Hamaspik Choice Inc Medicare	$444.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$400.26
Rate for Payer: Healthfirst Medicare Advantage	$444.73
Rate for Payer: Healthfirst QHP	$444.73
Rate for Payer: Humana Medicare	$453.62
Rate for Payer: Senior Whole Health Medicare Advantage	$444.73
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: United Healthcare Medicare Advantage	$444.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$444.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$355.78
Rate for Payer: Wellcare Medicare	$422.49

MR ABDOMEN C+

Facility

$1,156.53

Service Code	HCPCS 74182 TC
Hospital Charge Code	41403004
Hospital Revenue Code	610
Rate for Payer: Cash Price	$444.73

MR ABDOMEN C-

Facility

$705.83

Service Code	HCPCS 74181 TC
Hospital Charge Code	41407558
Hospital Revenue Code	610
Min. Negotiated Rate	$198.36
Max. Negotiated Rate	$686.36
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	$529.37
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	$686.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$580.77
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$198.36
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 Commercial	$274.34
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

MR ABDOMEN C-

Facility

$705.83

Service Code	HCPCS 74181 TC
Hospital Charge Code	41407558
Hospital Revenue Code	610
Rate for Payer: Cash Price	$283.37

MR ABDOMEN C-/C+

Facility

$1,156.53

Service Code	HCPCS 74183 TC
Hospital Charge Code	41407906
Hospital Revenue Code	610
Rate for Payer: Cash Price	$444.73

MR ABDOMEN C-/C+

Facility

$1,156.53

Service Code	HCPCS 74183 TC
Hospital Charge Code	41407906
Hospital Revenue Code	610
Min. Negotiated Rate	$311.31
Max. Negotiated Rate	$1,067.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$636.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$444.73
Rate for Payer: Aetna Government	$444.73
Rate for Payer: Affinity Essential Plan 1&2	$311.31
Rate for Payer: Affinity Essential Plan 3&4	$311.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$311.31
Rate for Payer: Brighton Health Commercial	$867.40
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cash Price	$444.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$444.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,067.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$903.66
Rate for Payer: Elderplan Medicare Advantage	$444.73
Rate for Payer: EmblemHealth Commercial	$311.31
Rate for Payer: Fidelis Essential Plan Aliesa	$378.02
Rate for Payer: Fidelis Essential Plan QHP	$395.81
Rate for Payer: Fidelis Medicare Advantage	$444.73
Rate for Payer: Fidelis Qualified Health Plan	$395.81
Rate for Payer: Group Health Inc Commercial	$400.26
Rate for Payer: Group Health Inc Medicare	$400.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.26
Rate for Payer: Hamaspik Choice Inc Medicare	$444.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$400.26
Rate for Payer: Healthfirst Medicare Advantage	$444.73
Rate for Payer: Healthfirst QHP	$444.73
Rate for Payer: Humana Medicare	$453.62
Rate for Payer: Senior Whole Health Medicare Advantage	$444.73
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: United Healthcare Medicare Advantage	$444.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$444.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$355.78
Rate for Payer: Wellcare Medicare	$422.49

MR ABDOMINAL AORTA C+

Facility

$1,374.83

Service Code	HCPCS 74185 TC
Hospital Charge Code	41407380
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,031.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,031.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,030.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$871.55
Rate for Payer: Group Health Inc Commercial	$687.42
Rate for Payer: Group Health Inc Medicare	$481.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.42
Rate for Payer: Hamaspik Choice Inc Medicare	$687.42
Rate for Payer: United Healthcare Commercial	$295.18

MR ABDOMINAL AORTA C-

Facility

$1,374.83

Service Code	HCPCS 74185 TC
Hospital Charge Code	41407552
Hospital Revenue Code	610
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,031.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,031.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,030.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$871.55
Rate for Payer: Group Health Inc Commercial	$687.42
Rate for Payer: Group Health Inc Medicare	$481.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.42
Rate for Payer: Hamaspik Choice Inc Medicare	$687.42
Rate for Payer: United Healthcare Commercial	$295.18

MRA CHEST

Facility

$1,374.88

Service Code	HCPCS 71555 TC
Hospital Charge Code	41403062
Hospital Revenue Code	619
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,035.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,031.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,035.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$876.02
Rate for Payer: Group Health Inc Commercial	$687.44
Rate for Payer: Group Health Inc Medicare	$481.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.44
Rate for Payer: Hamaspik Choice Inc Medicare	$687.44
Rate for Payer: United Healthcare Commercial	$295.46

MR ADRENAL GLAND(S) C+

Facility

$1,156.53

Service Code	HCPCS 74182 TC
Hospital Charge Code	41407383
Hospital Revenue Code	610
Min. Negotiated Rate	$311.31
Max. Negotiated Rate	$874.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$636.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$444.73
Rate for Payer: Aetna Government	$444.73
Rate for Payer: Affinity Essential Plan 1&2	$311.31
Rate for Payer: Affinity Essential Plan 3&4	$311.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$311.31
Rate for Payer: Brighton Health Commercial	$867.40
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cash Price	$444.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$444.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$874.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$740.04
Rate for Payer: Elderplan Medicare Advantage	$444.73
Rate for Payer: EmblemHealth Commercial	$311.31
Rate for Payer: Fidelis Essential Plan Aliesa	$378.02
Rate for Payer: Fidelis Essential Plan QHP	$395.81
Rate for Payer: Fidelis Medicare Advantage	$444.73
Rate for Payer: Fidelis Qualified Health Plan	$395.81
Rate for Payer: Group Health Inc Commercial	$400.26
Rate for Payer: Group Health Inc Medicare	$400.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.26
Rate for Payer: Hamaspik Choice Inc Medicare	$444.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$400.26
Rate for Payer: Healthfirst Medicare Advantage	$444.73
Rate for Payer: Healthfirst QHP	$444.73
Rate for Payer: Humana Medicare	$453.62
Rate for Payer: Senior Whole Health Medicare Advantage	$444.73
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: United Healthcare Medicare Advantage	$444.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$444.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$355.78
Rate for Payer: Wellcare Medicare	$422.49

Know your out-of-pocket cost for care.

All Charges