St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

N BLOCK INJ SCIATIC SNG

Facility

$1,893.13

Service Code	HCPCS 64445
Hospital Charge Code	30302497
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.72
Rate for Payer: Aetna Government	$799.72
Rate for Payer: Affinity Essential Plan 1&2	$559.80
Rate for Payer: Affinity Essential Plan 3&4	$559.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.80
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.72
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	$799.72
Rate for Payer: Fidelis Essential Plan Aliesa	$679.76
Rate for Payer: Fidelis Essential Plan QHP	$711.75
Rate for Payer: Fidelis Medicare Advantage	$799.72
Rate for Payer: Fidelis Qualified Health Plan	$711.75
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	$946.56
Rate for Payer: Hamaspik Choice Inc Medicare	$799.72
Rate for Payer: Healthfirst Medicare Advantage	$679.76
Rate for Payer: Healthfirst QHP	$799.72
Rate for Payer: Humana Medicare	$815.71
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$799.72
Rate for Payer: Senior Whole Health Medicare Advantage	$799.72
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$799.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$639.78
Rate for Payer: Wellcare Medicare	$759.73

N BLOCK INJ SCIATIC SNG

Facility

$1,893.13

Service Code	HCPCS 64445
Hospital Charge Code	30302497
Hospital Revenue Code	510
Rate for Payer: Cash Price	$799.72

NBLOCK INJ SPINAL ACCESSOR

Facility

$792.83

Service Code	HCPCS 64999
Hospital Charge Code	30302494
Hospital Revenue Code	510
Rate for Payer: Cash Price	$342.51

NBLOCK INJ SPINAL ACCESSOR

Facility

$792.83

Service Code	HCPCS 64999
Hospital Charge Code	30302494
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Affinity Essential Plan 1&2	$239.76
Rate for Payer: Affinity Essential Plan 3&4	$239.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$239.76
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
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	$342.51
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
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	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst Medicare Advantage	$291.13
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: Humana Medicare	$349.36
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

NBLOCK INJ SPINAL ACCESSOR

Facility

$792.83

Service Code	HCPCS 64999
Hospital Charge Code	40009842
Hospital Revenue Code	360
Min. Negotiated Rate	$239.76
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Affinity Essential Plan 1&2	$239.76
Rate for Payer: Affinity Essential Plan 3&4	$239.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$239.76
Rate for Payer: Brighton Health Commercial	$594.62
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
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	$342.51
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
Rate for Payer: Group Health Inc Commercial	$342.51
Rate for Payer: Group Health Inc Medicare	$342.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst Medicare Advantage	$291.13
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: Humana Medicare	$349.36
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

NBLOCK INJ SPINAL ACCESSOR

Facility

$792.83

Service Code	HCPCS 64999
Hospital Charge Code	40009842
Hospital Revenue Code	360
Rate for Payer: Cash Price	$342.51

N BLOCK INJ SUPRASCAPULAR

Facility

$1,898.00

Service Code	HCPCS 64418
Hospital Charge Code	40004376
Hospital Revenue Code	360
Min. Negotiated Rate	$559.80
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.72
Rate for Payer: Aetna Government	$799.72
Rate for Payer: Affinity Essential Plan 1&2	$559.80
Rate for Payer: Affinity Essential Plan 3&4	$559.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.80
Rate for Payer: Brighton Health Commercial	$1,423.50
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.72
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	$799.72
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$679.76
Rate for Payer: Fidelis Essential Plan QHP	$711.75
Rate for Payer: Fidelis Medicare Advantage	$799.72
Rate for Payer: Fidelis Qualified Health Plan	$711.75
Rate for Payer: Group Health Inc Commercial	$799.72
Rate for Payer: Group Health Inc Medicare	$799.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$949.00
Rate for Payer: Hamaspik Choice Inc Medicare	$799.72
Rate for Payer: Healthfirst Medicare Advantage	$679.76
Rate for Payer: Healthfirst QHP	$799.72
Rate for Payer: Humana Medicare	$815.71
Rate for Payer: Senior Whole Health Medicare Advantage	$799.72
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$799.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$639.78
Rate for Payer: Wellcare Medicare	$759.73

N BLOCK INJ SUPRASCAPULAR

Facility

$1,898.00

Service Code	HCPCS 64418
Hospital Charge Code	40004376
Hospital Revenue Code	360
Rate for Payer: Cash Price	$799.72

N BLOCK INJ SUPRASCAPULAR

Facility

$1,898.00

Service Code	HCPCS 64418
Hospital Charge Code	30302496
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$799.72
Rate for Payer: Aetna Government	$799.72
Rate for Payer: Affinity Essential Plan 1&2	$559.80
Rate for Payer: Affinity Essential Plan 3&4	$559.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$559.80
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Cash Price	$799.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$799.72
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	$799.72
Rate for Payer: Fidelis Essential Plan Aliesa	$679.76
Rate for Payer: Fidelis Essential Plan QHP	$711.75
Rate for Payer: Fidelis Medicare Advantage	$799.72
Rate for Payer: Fidelis Qualified Health Plan	$711.75
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	$949.00
Rate for Payer: Hamaspik Choice Inc Medicare	$799.72
Rate for Payer: Healthfirst Medicare Advantage	$679.76
Rate for Payer: Healthfirst QHP	$799.72
Rate for Payer: Humana Medicare	$815.71
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$799.72
Rate for Payer: Senior Whole Health Medicare Advantage	$799.72
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$799.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$799.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$639.78
Rate for Payer: Wellcare Medicare	$759.73

N BLOCK INJ SUPRASCAPULAR

Facility

$1,898.00

Service Code	HCPCS 64418
Hospital Charge Code	30302496
Hospital Revenue Code	510
Rate for Payer: Cash Price	$799.72

NCB 2.5MM DRILL BIT, L 24

Facility

$229.90

Hospital Charge Code	40006780
Hospital Revenue Code	272
Min. Negotiated Rate	$80.46
Max. Negotiated Rate	$183.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.95
Rate for Payer: Aetna Government	$114.95
Rate for Payer: Brighton Health Commercial	$172.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$183.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.33
Rate for Payer: Group Health Inc Commercial	$114.95
Rate for Payer: Group Health Inc Medicare	$80.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.95
Rate for Payer: Hamaspik Choice Inc Medicare	$114.95

NCB 2.5MM DRILL_BIT, L 24

Facility

$237.32

Hospital Charge Code	40006866
Hospital Revenue Code	272
Min. Negotiated Rate	$83.06
Max. Negotiated Rate	$189.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.66
Rate for Payer: Aetna Government	$118.66
Rate for Payer: Brighton Health Commercial	$177.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.38
Rate for Payer: Group Health Inc Commercial	$118.66
Rate for Payer: Group Health Inc Medicare	$83.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.66
Rate for Payer: Hamaspik Choice Inc Medicare	$118.66

NCB 2.5MM DRILL GUIDE, LO

Facility

$734.20

Hospital Charge Code	40006781
Hospital Revenue Code	272
Min. Negotiated Rate	$256.97
Max. Negotiated Rate	$587.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$367.10
Rate for Payer: Aetna Government	$367.10
Rate for Payer: Brighton Health Commercial	$550.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$587.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$499.26
Rate for Payer: Group Health Inc Commercial	$367.10
Rate for Payer: Group Health Inc Medicare	$256.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.10
Rate for Payer: Hamaspik Choice Inc Medicare	$367.10

NCB 3.3 DRILL BIT, 195MM

Facility

$252.16

Hospital Charge Code	40204622
Hospital Revenue Code	272
Min. Negotiated Rate	$88.26
Max. Negotiated Rate	$201.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.08
Rate for Payer: Aetna Government	$126.08
Rate for Payer: Brighton Health Commercial	$189.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$201.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$171.47
Rate for Payer: Group Health Inc Commercial	$126.08
Rate for Payer: Group Health Inc Medicare	$88.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

NCB 3.3 DRILL_BIT, 195MM

Facility

$252.16

Hospital Charge Code	40006743
Hospital Revenue Code	272
Min. Negotiated Rate	$88.26
Max. Negotiated Rate	$201.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.08
Rate for Payer: Aetna Government	$126.08
Rate for Payer: Brighton Health Commercial	$189.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$201.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$171.47
Rate for Payer: Group Health Inc Commercial	$126.08
Rate for Payer: Group Health Inc Medicare	$88.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.08
Rate for Payer: Hamaspik Choice Inc Medicare	$126.08

NCB 3.3 DRILL GUIDE

Facility

$585.88

Hospital Charge Code	40006737
Hospital Revenue Code	272
Min. Negotiated Rate	$205.06
Max. Negotiated Rate	$468.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$322.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$292.94
Rate for Payer: Aetna Government	$292.94
Rate for Payer: Brighton Health Commercial	$439.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$468.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$398.40
Rate for Payer: Group Health Inc Commercial	$292.94
Rate for Payer: Group Health Inc Medicare	$205.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$292.94
Rate for Payer: Hamaspik Choice Inc Medicare	$292.94

NCB 3.3MM CANN DRILL BIT 195MM QC

Facility

$378.22

Hospital Charge Code	40006742
Hospital Revenue Code	272
Min. Negotiated Rate	$132.38
Max. Negotiated Rate	$302.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$208.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$189.11
Rate for Payer: Aetna Government	$189.11
Rate for Payer: Brighton Health Commercial	$283.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$302.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$257.19
Rate for Payer: Group Health Inc Commercial	$189.11
Rate for Payer: Group Health Inc Medicare	$132.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.11
Rate for Payer: Hamaspik Choice Inc Medicare	$189.11

NCB 3.3MM DRILL BIT, L 24

Facility

$229.90

Hospital Charge Code	40006782
Hospital Revenue Code	272
Min. Negotiated Rate	$80.46
Max. Negotiated Rate	$183.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$126.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.95
Rate for Payer: Aetna Government	$114.95
Rate for Payer: Brighton Health Commercial	$172.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$183.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$156.33
Rate for Payer: Group Health Inc Commercial	$114.95
Rate for Payer: Group Health Inc Medicare	$80.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$114.95
Rate for Payer: Hamaspik Choice Inc Medicare	$114.95

NCB 3.3MM DRILL_BIT, L 24

Facility

$237.32

Hospital Charge Code	40006867
Hospital Revenue Code	272
Min. Negotiated Rate	$83.06
Max. Negotiated Rate	$189.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.66
Rate for Payer: Aetna Government	$118.66
Rate for Payer: Brighton Health Commercial	$177.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.38
Rate for Payer: Group Health Inc Commercial	$118.66
Rate for Payer: Group Health Inc Medicare	$83.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.66
Rate for Payer: Hamaspik Choice Inc Medicare	$118.66

NCB 3.3MM DRILL GUIDE, LO

Facility

$734.20

Hospital Charge Code	40006783
Hospital Revenue Code	272
Min. Negotiated Rate	$256.97
Max. Negotiated Rate	$587.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$367.10
Rate for Payer: Aetna Government	$367.10
Rate for Payer: Brighton Health Commercial	$550.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$587.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$499.26
Rate for Payer: Group Health Inc Commercial	$367.10
Rate for Payer: Group Health Inc Medicare	$256.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$367.10
Rate for Payer: Hamaspik Choice Inc Medicare	$367.10

NCB 4.0 DP THD SCR L=20MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006919
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB 4.0 DP THD SCR L=20MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40006919
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=20MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007100
Hospital Revenue Code	278
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$272.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$142.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$155.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$149.25
Rate for Payer: EmblemHealth Commercial	$129.78
Rate for Payer: Fidelis Medicare Advantage	$272.54
Rate for Payer: Group Health Inc Commercial	$129.78
Rate for Payer: Group Health Inc Medicare	$90.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$168.71

NCB_4.0 DP THD SCR L=20MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007100
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

NCB_4.0 DP THD SCR L=22MM

Facility

$259.56

Service Code	HCPCS C1713
Hospital Charge Code	40007101
Hospital Revenue Code	278
Min. Negotiated Rate	$129.78
Max. Negotiated Rate	$129.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.78
Rate for Payer: Hamaspik Choice Inc Medicare	$129.78

Know your out-of-pocket cost for care.

All Charges