St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NOBELZYGOMA 45D 45MM

Facility

$823.50

Service Code	HCPCS C1734
Hospital Charge Code	64907368
Hospital Revenue Code	278
Min. Negotiated Rate	$411.75
Max. Negotiated Rate	$411.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.75
Rate for Payer: Hamaspik Choice Inc Medicare	$411.75

NOBELZYGOMA 45D 45MM

Facility

$823.50

Service Code	HCPCS C1734
Hospital Charge Code	64907368
Hospital Revenue Code	278
Min. Negotiated Rate	$288.22
Max. Negotiated Rate	$864.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$452.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$411.75
Rate for Payer: Aetna Government	$411.75
Rate for Payer: Brighton Health Commercial	$494.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$473.51
Rate for Payer: EmblemHealth Commercial	$411.75
Rate for Payer: Fidelis Medicare Advantage	$864.68
Rate for Payer: Group Health Inc Commercial	$411.75
Rate for Payer: Group Health Inc Medicare	$288.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$411.75
Rate for Payer: Hamaspik Choice Inc Medicare	$411.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$535.28

NOBELZYGOMA 45D 50MM

Facility

$1,647.00

Service Code	HCPCS C1734
Hospital Charge Code	64907369
Hospital Revenue Code	278
Min. Negotiated Rate	$576.45
Max. Negotiated Rate	$1,729.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$905.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$823.50
Rate for Payer: Aetna Government	$823.50
Rate for Payer: Brighton Health Commercial	$988.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$823.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$947.02
Rate for Payer: EmblemHealth Commercial	$823.50
Rate for Payer: Fidelis Medicare Advantage	$1,729.35
Rate for Payer: Group Health Inc Commercial	$823.50
Rate for Payer: Group Health Inc Medicare	$576.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$823.50
Rate for Payer: Hamaspik Choice Inc Medicare	$823.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,070.55

NOBELZYGOMA 45D 50MM

Facility

$1,647.00

Service Code	HCPCS C1734
Hospital Charge Code	64907369
Hospital Revenue Code	278
Min. Negotiated Rate	$823.50
Max. Negotiated Rate	$823.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$823.50
Rate for Payer: Hamaspik Choice Inc Medicare	$823.50

NOBELZYGOMA 45D 52.5MM

Facility

$1,647.00

Service Code	HCPCS C1734
Hospital Charge Code	64907370
Hospital Revenue Code	278
Min. Negotiated Rate	$823.50
Max. Negotiated Rate	$823.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$823.50
Rate for Payer: Hamaspik Choice Inc Medicare	$823.50

NOBELZYGOMA 45D 52.5MM

Facility

$1,647.00

Service Code	HCPCS C1734
Hospital Charge Code	64907370
Hospital Revenue Code	278
Min. Negotiated Rate	$576.45
Max. Negotiated Rate	$1,729.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$905.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$823.50
Rate for Payer: Aetna Government	$823.50
Rate for Payer: Brighton Health Commercial	$988.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$823.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$947.02
Rate for Payer: EmblemHealth Commercial	$823.50
Rate for Payer: Fidelis Medicare Advantage	$1,729.35
Rate for Payer: Group Health Inc Commercial	$823.50
Rate for Payer: Group Health Inc Medicare	$576.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$823.50
Rate for Payer: Hamaspik Choice Inc Medicare	$823.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,070.55

NO CAREGIVER

Facility

$0.01

Service Code	HCPCS G2184
Hospital Charge Code	30300312
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$94.00

NO ELECTRODIAG POLYNEURO 6MN

Facility

$0.01

Service Code	HCPCS 3752F
Hospital Charge Code	30300376
Hospital Revenue Code	969
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
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: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

NON-ARTHROSCOPIC TMJ LAVAGE

Facility

$1,063.00

Service Code	HCPCS D7871
Hospital Charge Code	42303331
Hospital Revenue Code	361
Min. Negotiated Rate	$168.60
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$584.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$168.60
Rate for Payer: Aetna Government	$168.60
Rate for Payer: Brighton Health Commercial	$797.25
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: Group Health Inc Commercial	$531.50
Rate for Payer: Group Health Inc Medicare	$372.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.50
Rate for Payer: Hamaspik Choice Inc Medicare	$531.50

NON-AUTO GRAFT ADDL TOOTH

Facility

$1,875.00

Service Code	HCPCS D4285
Hospital Charge Code	42303465
Hospital Revenue Code	361
Min. Negotiated Rate	$346.49
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,031.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$346.49
Rate for Payer: Aetna Government	$346.49
Rate for Payer: Brighton Health Commercial	$1,406.25
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: Group Health Inc Commercial	$937.50
Rate for Payer: Group Health Inc Medicare	$656.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$937.50
Rate for Payer: Hamaspik Choice Inc Medicare	$937.50

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$51,157.03

Service Code	MSDRG 098
Min. Negotiated Rate	$17,300.38
Max. Negotiated Rate	$51,157.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31,768.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37,205.11
Rate for Payer: Aetna Government	$37,205.11
Rate for Payer: Brighton Health Commercial	$31,240.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$37,949.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$37,206.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$30,704.04
Rate for Payer: Elderplan Medicare Advantage	$35,344.85
Rate for Payer: EmblemHealth Commercial	$18,474.80
Rate for Payer: Fidelis Medicare Advantage	$37,205.11
Rate for Payer: Group Health Inc Commercial	$37,205.11
Rate for Payer: Group Health Inc Medicare	$37,205.11
Rate for Payer: Hamaspik Choice Inc Medicare	$37,205.11
Rate for Payer: Healthfirst Medicare Advantage	$17,300.38
Rate for Payer: Humana Medicare	$51,157.03
Rate for Payer: Senior Whole Health Medicare Advantage	$37,205.11
Rate for Payer: United Healthcare Commercial	$42,846.54
Rate for Payer: United Healthcare Medicare Advantage	$37,205.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37,205.11
Rate for Payer: Wellcare Medicare	$35,344.85

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$79,422.93

Service Code	MSDRG 097
Min. Negotiated Rate	$26,859.39
Max. Negotiated Rate	$79,422.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53,626.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57,762.13
Rate for Payer: Aetna Government	$57,762.13
Rate for Payer: Brighton Health Commercial	$52,735.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$58,917.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62,805.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$51,829.90
Rate for Payer: Elderplan Medicare Advantage	$54,874.02
Rate for Payer: EmblemHealth Commercial	$31,186.40
Rate for Payer: Fidelis Medicare Advantage	$57,762.13
Rate for Payer: Group Health Inc Commercial	$57,762.13
Rate for Payer: Group Health Inc Medicare	$57,762.13
Rate for Payer: Hamaspik Choice Inc Medicare	$57,762.13
Rate for Payer: Healthfirst Medicare Advantage	$26,859.39
Rate for Payer: Humana Medicare	$79,422.93
Rate for Payer: Senior Whole Health Medicare Advantage	$57,762.13
Rate for Payer: United Healthcare Commercial	$72,327.03
Rate for Payer: United Healthcare Medicare Advantage	$57,762.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57,762.13
Rate for Payer: Wellcare Medicare	$54,874.02

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$35,248.90

Service Code	MSDRG 099
Min. Negotiated Rate	$11,320.70
Max. Negotiated Rate	$35,248.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19,466.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25,635.56
Rate for Payer: Aetna Government	$25,635.56
Rate for Payer: Brighton Health Commercial	$19,142.90
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$26,148.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22,798.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$18,814.33
Rate for Payer: Elderplan Medicare Advantage	$24,353.78
Rate for Payer: EmblemHealth Commercial	$11,320.70
Rate for Payer: Fidelis Medicare Advantage	$25,635.56
Rate for Payer: Group Health Inc Commercial	$25,635.56
Rate for Payer: Group Health Inc Medicare	$25,635.56
Rate for Payer: Hamaspik Choice Inc Medicare	$25,635.56
Rate for Payer: Healthfirst Medicare Advantage	$11,920.54
Rate for Payer: Humana Medicare	$35,248.90
Rate for Payer: Senior Whole Health Medicare Advantage	$25,635.56
Rate for Payer: United Healthcare Commercial	$26,254.82
Rate for Payer: United Healthcare Medicare Advantage	$25,635.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25,635.56
Rate for Payer: Wellcare Medicare	$24,353.78

NO NECK FS PROM NO RSN

Facility

$0.01

Service Code	HCPCS G2210
Hospital Charge Code	30300338
Hospital Revenue Code	929
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$94.00

NON-EXTENSIVE BURNS

Facility

$48,994.76

Service Code	MSDRG 935
Min. Negotiated Rate	$16,569.14
Max. Negotiated Rate	$48,994.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30,096.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35,632.55
Rate for Payer: Aetna Government	$35,632.55
Rate for Payer: Brighton Health Commercial	$29,595.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$36,345.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35,247.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$29,087.96
Rate for Payer: Elderplan Medicare Advantage	$33,850.92
Rate for Payer: EmblemHealth Commercial	$17,502.40
Rate for Payer: Fidelis Medicare Advantage	$35,632.55
Rate for Payer: Group Health Inc Commercial	$35,632.55
Rate for Payer: Group Health Inc Medicare	$35,632.55
Rate for Payer: Hamaspik Choice Inc Medicare	$35,632.55
Rate for Payer: Healthfirst Medicare Advantage	$16,569.14
Rate for Payer: Humana Medicare	$48,994.76
Rate for Payer: Senior Whole Health Medicare Advantage	$35,632.55
Rate for Payer: United Healthcare Commercial	$40,591.36
Rate for Payer: United Healthcare Medicare Advantage	$35,632.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35,632.55
Rate for Payer: Wellcare Medicare	$33,850.92

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$42,433.60

Service Code	MSDRG 988
Min. Negotiated Rate	$14,350.27
Max. Negotiated Rate	$42,433.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25,022.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30,860.80
Rate for Payer: Aetna Government	$30,860.80
Rate for Payer: Brighton Health Commercial	$24,606.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$31,478.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29,305.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,184.15
Rate for Payer: Elderplan Medicare Advantage	$29,317.76
Rate for Payer: EmblemHealth Commercial	$14,551.80
Rate for Payer: Fidelis Medicare Advantage	$30,860.80
Rate for Payer: Group Health Inc Commercial	$30,860.80
Rate for Payer: Group Health Inc Medicare	$30,860.80
Rate for Payer: Hamaspik Choice Inc Medicare	$30,860.80
Rate for Payer: Healthfirst Medicare Advantage	$14,350.27
Rate for Payer: Humana Medicare	$42,433.60
Rate for Payer: Senior Whole Health Medicare Advantage	$30,860.80
Rate for Payer: United Healthcare Commercial	$33,748.24
Rate for Payer: United Healthcare Medicare Advantage	$30,860.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$30,860.80
Rate for Payer: Wellcare Medicare	$29,317.76

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$74,461.54

Service Code	MSDRG 987
Min. Negotiated Rate	$25,181.54
Max. Negotiated Rate	$74,461.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49,789.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54,153.85
Rate for Payer: Aetna Government	$54,153.85
Rate for Payer: Brighton Health Commercial	$48,962.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$55,236.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58,312.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$48,121.76
Rate for Payer: Elderplan Medicare Advantage	$51,446.16
Rate for Payer: EmblemHealth Commercial	$28,955.20
Rate for Payer: Fidelis Medicare Advantage	$54,153.85
Rate for Payer: Group Health Inc Commercial	$54,153.85
Rate for Payer: Group Health Inc Medicare	$54,153.85
Rate for Payer: Hamaspik Choice Inc Medicare	$54,153.85
Rate for Payer: Healthfirst Medicare Advantage	$25,181.54
Rate for Payer: Humana Medicare	$74,461.54
Rate for Payer: Senior Whole Health Medicare Advantage	$54,153.85
Rate for Payer: United Healthcare Commercial	$67,152.43
Rate for Payer: United Healthcare Medicare Advantage	$54,153.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54,153.85
Rate for Payer: Wellcare Medicare	$51,446.16

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$30,674.54

Service Code	MSDRG 989
Min. Negotiated Rate	$9,263.57
Max. Negotiated Rate	$30,674.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,929.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22,308.76
Rate for Payer: Aetna Government	$22,308.76
Rate for Payer: Brighton Health Commercial	$15,664.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$22,754.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,655.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$15,395.48
Rate for Payer: Elderplan Medicare Advantage	$21,193.32
Rate for Payer: EmblemHealth Commercial	$9,263.57
Rate for Payer: Fidelis Medicare Advantage	$22,308.76
Rate for Payer: Group Health Inc Commercial	$22,308.76
Rate for Payer: Group Health Inc Medicare	$22,308.76
Rate for Payer: Hamaspik Choice Inc Medicare	$22,308.76
Rate for Payer: Healthfirst Medicare Advantage	$10,373.57
Rate for Payer: Humana Medicare	$30,674.54
Rate for Payer: Senior Whole Health Medicare Advantage	$22,308.76
Rate for Payer: United Healthcare Commercial	$21,483.93
Rate for Payer: United Healthcare Medicare Advantage	$22,308.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22,308.76
Rate for Payer: Wellcare Medicare	$21,193.32

NON GYN THIN PREP PAP CHARGE ONLY

Facility

$149.83

Service Code	HCPCS 88112
Hospital Charge Code	40635510
Hospital Revenue Code	310
Min. Negotiated Rate	$43.86
Max. Negotiated Rate	$82.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.66
Rate for Payer: Aetna Government	$62.66
Rate for Payer: Affinity Essential Plan 1&2	$43.86
Rate for Payer: Affinity Essential Plan 3&4	$43.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.86
Rate for Payer: Brighton Health Commercial	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.18
Rate for Payer: Elderplan Medicare Advantage	$62.66
Rate for Payer: EmblemHealth Commercial	$62.66
Rate for Payer: Fidelis Essential Plan Aliesa	$53.26
Rate for Payer: Fidelis Essential Plan QHP	$55.77
Rate for Payer: Fidelis Medicare Advantage	$62.66
Rate for Payer: Fidelis Qualified Health Plan	$55.77
Rate for Payer: Group Health Inc Commercial	$62.66
Rate for Payer: Group Health Inc Medicare	$62.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.92
Rate for Payer: Hamaspik Choice Inc Medicare	$62.66
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$62.66
Rate for Payer: Humana Medicare	$63.91
Rate for Payer: Senior Whole Health Medicare Advantage	$62.66
Rate for Payer: United Healthcare Medicare Advantage	$62.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.13
Rate for Payer: Wellcare Medicare	$56.39

NON GYN THIN PREP PAP CHARGE ONLY

Facility

$149.83

Service Code	HCPCS 88112
Hospital Charge Code	40635510
Hospital Revenue Code	310
Rate for Payer: Cash Price	$62.66

NON-INTRAVEN. CONSCIOUS SEDATION

Facility

$106.00

Service Code	HCPCS D9248
Hospital Charge Code	42303374
Hospital Revenue Code	361
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$9,862.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.30
Rate for Payer: Aetna Government	$25.30
Rate for Payer: Affinity Essential Plan 1&2	$221.90
Rate for Payer: Affinity Essential Plan 3&4	$221.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$98.62
Rate for Payer: Amida Care Medicaid	$98.62
Rate for Payer: Brighton Health Commercial	$79.50
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: Fidelis CHP/HARP/Medicaid	$9,862.00
Rate for Payer: Fidelis Essential Plan Aliesa	$98.62
Rate for Payer: Fidelis Essential Plan QHP	$98.62
Rate for Payer: Fidelis Qualified Health Plan	$103.55
Rate for Payer: Group Health Inc Commercial	$53.00
Rate for Payer: Group Health Inc Medicare	$37.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$98.62
Rate for Payer: Hamaspik Choice Inc Medicare	$53.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$98.62
Rate for Payer: Healthfirst Essential Plan	$221.90
Rate for Payer: Healthfirst QHP	$98.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.62
Rate for Payer: SOMOS Essential	$221.90
Rate for Payer: United Healthcare Essential Plan 1&2	$221.90
Rate for Payer: United Healthcare Essential Plan 3&4	$108.48
Rate for Payer: United Healthcare Medicaid	$98.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$98.62

NON-LATEX SHEATH INS TRAY

Facility

$68.94

Hospital Charge Code	64901785
Hospital Revenue Code	270
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$55.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.47
Rate for Payer: Aetna Government	$34.47
Rate for Payer: Brighton Health Commercial	$51.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.88
Rate for Payer: Group Health Inc Commercial	$34.47
Rate for Payer: Group Health Inc Medicare	$24.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.47
Rate for Payer: Hamaspik Choice Inc Medicare	$34.47

NON LOCKING SCREW 2.3 X 12MM

Facility

$112.00

Service Code	HCPCS C1713
Hospital Charge Code	40201258
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$67.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.40
Rate for Payer: EmblemHealth Commercial	$56.00
Rate for Payer: Fidelis Medicare Advantage	$117.60
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.80

NON LOCKING SCREW 2.3 X 12MM

Facility

$112.00

Service Code	HCPCS C1713
Hospital Charge Code	40201258
Hospital Revenue Code	278
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$56.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00

NON LOCKING SCREW 2.3 X 14MM

Facility

$112.00

Service Code	HCPCS C1713
Hospital Charge Code	40201259
Hospital Revenue Code	278
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$67.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$64.40
Rate for Payer: EmblemHealth Commercial	$56.00
Rate for Payer: Fidelis Medicare Advantage	$117.60
Rate for Payer: Group Health Inc Commercial	$56.00
Rate for Payer: Group Health Inc Medicare	$39.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.00
Rate for Payer: Hamaspik Choice Inc Medicare	$56.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.80

Know your out-of-pocket cost for care.

All Charges