St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NORMAL SALINE FLUSH 0.9 % IV SOLN [117515]

Facility

$0.37

Service Code	NDC 64253011130
Hospital Charge Code	64253011130
Hospital Revenue Code	278
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

NORMAL SALINE/NEBULIZER BID

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306328
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER BID

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306328
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER Q1H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306321
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER Q1H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306321
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER Q2H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306322
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER Q2H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306322
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER Q3H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306323
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER Q3H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306323
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER Q4H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306324
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER Q4H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306324
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER Q6H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306325
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER Q6H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306325
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER Q8H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306326
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER Q8H

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306326
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER QID

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306327
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER QID

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306327
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE/NEBULIZER TID

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306329
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE/NEBULIZER TID

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306329
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE TREATMENT ADM.

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306211
Hospital Revenue Code	410
Min. Negotiated Rate	$132.45
Max. Negotiated Rate	$417.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$246.65
Rate for Payer: Aetna Government	$246.65
Rate for Payer: Affinity Essential Plan 1&2	$172.66
Rate for Payer: Affinity Essential Plan 3&4	$172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.66
Rate for Payer: Brighton Health Commercial	$417.88
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Cash Price	$246.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$246.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$132.45
Rate for Payer: Elderplan Medicare Advantage	$246.65
Rate for Payer: EmblemHealth Commercial	$246.65
Rate for Payer: Fidelis Essential Plan Aliesa	$209.65
Rate for Payer: Fidelis Essential Plan QHP	$219.52
Rate for Payer: Fidelis Medicare Advantage	$246.65
Rate for Payer: Fidelis Qualified Health Plan	$219.52
Rate for Payer: Group Health Inc Commercial	$246.65
Rate for Payer: Group Health Inc Medicare	$246.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.59
Rate for Payer: Hamaspik Choice Inc Medicare	$246.65
Rate for Payer: Healthfirst Medicare Advantage	$209.65
Rate for Payer: Healthfirst QHP	$246.65
Rate for Payer: Humana Medicare	$251.58
Rate for Payer: Senior Whole Health Medicare Advantage	$246.65
Rate for Payer: United Healthcare Commercial	$278.59
Rate for Payer: United Healthcare Medicare Advantage	$246.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$246.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$197.32
Rate for Payer: Wellcare Medicare	$234.32

NORMAL SALINE TREATMENT ADM.

Facility

$557.18

Service Code	HCPCS 94640
Hospital Charge Code	40306211
Hospital Revenue Code	410
Rate for Payer: Cash Price	$246.65

NORMAL SALINE W/HEPRIN

Facility

$8.15

Hospital Charge Code	42905325
Hospital Revenue Code	801
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$6.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$6.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.54
Rate for Payer: Group Health Inc Commercial	$4.08
Rate for Payer: Group Health Inc Medicare	$2.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4.08

NORPORT CATHETER

Facility

$713.36

Hospital Charge Code	40207011
Hospital Revenue Code	270
Min. Negotiated Rate	$249.68
Max. Negotiated Rate	$570.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$392.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$356.68
Rate for Payer: Aetna Government	$356.68
Rate for Payer: Brighton Health Commercial	$535.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$570.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$485.08
Rate for Payer: Group Health Inc Commercial	$356.68
Rate for Payer: Group Health Inc Medicare	$249.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$356.68
Rate for Payer: Hamaspik Choice Inc Medicare	$356.68

NO RSN NO BRIEF COUNS

Facility

$0.01

Service Code	HCPCS G2202
Hospital Charge Code	30300330
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

NORTHERN LITHOTRIPSY

Facility

$1,000.00

Hospital Charge Code	40205003
Hospital Revenue Code	790
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$3,383.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$500.00
Rate for Payer: Aetna Government	$500.00
Rate for Payer: Brighton Health Commercial	$3,383.00
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

Know your out-of-pocket cost for care.

All Charges