St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [88704]

Facility

$16.72

Service Code	NDC 00004080285
Hospital Charge Code	00004080285
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$13.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.36
Rate for Payer: Aetna Government	$8.36
Rate for Payer: Brighton Health Commercial	$12.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.37
Rate for Payer: Group Health Inc Commercial	$8.36
Rate for Payer: Group Health Inc Medicare	$5.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.36
Rate for Payer: Hamaspik Choice Inc Medicare	$8.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.87

OSELTAMIVIR PHOSPHATE 45 MG PO CAPS [88705]

Facility

$14.18

Service Code	NDC 62332041410
Hospital Charge Code	62332041410
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.09
Rate for Payer: Aetna Government	$7.09
Rate for Payer: Brighton Health Commercial	$10.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.64
Rate for Payer: Group Health Inc Commercial	$7.09
Rate for Payer: Group Health Inc Medicare	$4.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.09
Rate for Payer: Hamaspik Choice Inc Medicare	$7.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

OSELTAMIVIR PHOSPHATE 45 MG PO CAPS [88705]

Facility

$14.18

Service Code	NDC 68180067611
Hospital Charge Code	68180067611
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.09
Rate for Payer: Aetna Government	$7.09
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.64
Rate for Payer: Group Health Inc Commercial	$7.09
Rate for Payer: Group Health Inc Medicare	$4.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.09
Rate for Payer: Hamaspik Choice Inc Medicare	$7.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

OSELTAMIVIR PHOSPHATE 45 MG PO CAPS [88705]

Facility

$16.72

Service Code	NDC 00004080185
Hospital Charge Code	00004080185
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$13.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.36
Rate for Payer: Aetna Government	$8.36
Rate for Payer: Brighton Health Commercial	$12.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.37
Rate for Payer: Group Health Inc Commercial	$8.36
Rate for Payer: Group Health Inc Medicare	$5.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.36
Rate for Payer: Hamaspik Choice Inc Medicare	$8.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.87

OSELTAMIVIR PHOSPHATE 6MG/ML

Facility

$92.14

Hospital Charge Code	41657016
Hospital Revenue Code	250
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$73.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.07
Rate for Payer: Aetna Government	$46.07
Rate for Payer: Brighton Health Commercial	$69.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.66
Rate for Payer: Group Health Inc Commercial	$46.07
Rate for Payer: Group Health Inc Medicare	$32.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.07
Rate for Payer: Hamaspik Choice Inc Medicare	$46.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.89

OSELTAMIVIR PHOSPHATE 6MG/ML

Facility

$92.14

Hospital Charge Code	41647016
Hospital Revenue Code	250
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$73.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.07
Rate for Payer: Aetna Government	$46.07
Rate for Payer: Brighton Health Commercial	$69.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.66
Rate for Payer: Group Health Inc Commercial	$46.07
Rate for Payer: Group Health Inc Medicare	$32.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.07
Rate for Payer: Hamaspik Choice Inc Medicare	$46.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.89

OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR [110998]

Facility

$2.73

Service Code	NDC 68180067801
Hospital Charge Code	68180067801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.77

OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR [110998]

Facility

$3.04

Service Code	NDC 00004082205
Hospital Charge Code	00004082205
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR [110998]

Facility

$2.73

Service Code	NDC 27241013909
Hospital Charge Code	27241013909
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.37
Rate for Payer: Aetna Government	$1.37
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR [110998]

Facility

$2.73

Service Code	NDC 70710116506
Hospital Charge Code	70710116506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.37
Rate for Payer: Aetna Government	$1.37
Rate for Payer: Brighton Health Commercial	$2.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.86
Rate for Payer: Group Health Inc Commercial	$1.37
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.37
Rate for Payer: Hamaspik Choice Inc Medicare	$1.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.78

OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]

Facility

$15.46

Service Code	NDC 47781047013
Hospital Charge Code	47781047013
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.51
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]

Facility

$15.46

Service Code	NDC 68180067711
Hospital Charge Code	68180067711
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.51
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]

Facility

$18.23

Service Code	NDC 00004080085
Hospital Charge Code	00004080085
Hospital Revenue Code	250
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$14.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.11
Rate for Payer: Aetna Government	$9.11
Rate for Payer: Brighton Health Commercial	$13.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.39
Rate for Payer: Group Health Inc Commercial	$9.11
Rate for Payer: Group Health Inc Medicare	$6.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.11
Rate for Payer: Hamaspik Choice Inc Medicare	$9.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.85

OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]

Facility

$15.46

Service Code	NDC 72205004411
Hospital Charge Code	72205004411
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.51
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]

Facility

$15.46

Service Code	NDC 62332041510
Hospital Charge Code	62332041510
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.51
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]

Facility

$15.46

Service Code	NDC 33342025866
Hospital Charge Code	33342025866
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.51
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]

Facility

$15.46

Service Code	NDC 69238126601
Hospital Charge Code	69238126601
Hospital Revenue Code	250
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$12.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.73
Rate for Payer: Aetna Government	$7.73
Rate for Payer: Brighton Health Commercial	$11.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.51
Rate for Payer: Group Health Inc Commercial	$7.73
Rate for Payer: Group Health Inc Medicare	$5.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.73
Rate for Payer: Hamaspik Choice Inc Medicare	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.05

OSMOLALITY BLOOD

Facility

$16.53

Service Code	HCPCS 83930
Hospital Charge Code	40602380
Hospital Revenue Code	301
Rate for Payer: Cash Price	$6.61

OSMOLALITY BLOOD

Facility

$16.53

Service Code	HCPCS 83930
Hospital Charge Code	40602380
Hospital Revenue Code	301
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$12.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.61
Rate for Payer: Aetna Government	$6.61
Rate for Payer: Affinity Essential Plan 1&2	$4.63
Rate for Payer: Affinity Essential Plan 3&4	$4.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.63
Rate for Payer: Brighton Health Commercial	$12.40
Rate for Payer: Cash Price	$6.61
Rate for Payer: Cash Price	$6.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.90
Rate for Payer: Elderplan Medicare Advantage	$6.61
Rate for Payer: EmblemHealth Commercial	$6.61
Rate for Payer: Fidelis Essential Plan Aliesa	$5.62
Rate for Payer: Fidelis Essential Plan QHP	$5.88
Rate for Payer: Fidelis Medicare Advantage	$6.61
Rate for Payer: Fidelis Qualified Health Plan	$5.88
Rate for Payer: Group Health Inc Commercial	$6.61
Rate for Payer: Group Health Inc Medicare	$6.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.26
Rate for Payer: Hamaspik Choice Inc Medicare	$6.61
Rate for Payer: Healthfirst Medicare Advantage	$6.61
Rate for Payer: Healthfirst QHP	$6.61
Rate for Payer: Humana Medicare	$6.74
Rate for Payer: Senior Whole Health Medicare Advantage	$6.61
Rate for Payer: United Healthcare Commercial	$8.37
Rate for Payer: United Healthcare Medicare Advantage	$6.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.29
Rate for Payer: Wellcare Medicare	$5.95

OSMOLALITY, FECAL

Facility

$12.95

Service Code	HCPCS 84999
Hospital Charge Code	40609133
Hospital Revenue Code	300
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$9.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$9.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.31
Rate for Payer: Group Health Inc Commercial	$6.48
Rate for Payer: Group Health Inc Medicare	$4.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.48
Rate for Payer: Hamaspik Choice Inc Medicare	$6.48

OSMOLALITY URINE

Facility

$17.05

Service Code	HCPCS 83935
Hospital Charge Code	40602295
Hospital Revenue Code	301
Rate for Payer: Cash Price	$6.82

OSMOLALITY URINE

Facility

$17.05

Service Code	HCPCS 83935
Hospital Charge Code	40602295
Hospital Revenue Code	301
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$12.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.82
Rate for Payer: Aetna Government	$6.82
Rate for Payer: Affinity Essential Plan 1&2	$4.77
Rate for Payer: Affinity Essential Plan 3&4	$4.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.77
Rate for Payer: Brighton Health Commercial	$12.79
Rate for Payer: Cash Price	$6.82
Rate for Payer: Cash Price	$6.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.16
Rate for Payer: Elderplan Medicare Advantage	$6.82
Rate for Payer: EmblemHealth Commercial	$6.82
Rate for Payer: Fidelis Essential Plan Aliesa	$5.80
Rate for Payer: Fidelis Essential Plan QHP	$6.07
Rate for Payer: Fidelis Medicare Advantage	$6.82
Rate for Payer: Fidelis Qualified Health Plan	$6.07
Rate for Payer: Group Health Inc Commercial	$6.82
Rate for Payer: Group Health Inc Medicare	$6.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.52
Rate for Payer: Hamaspik Choice Inc Medicare	$6.82
Rate for Payer: Healthfirst Medicare Advantage	$6.82
Rate for Payer: Healthfirst QHP	$6.82
Rate for Payer: Humana Medicare	$6.96
Rate for Payer: Senior Whole Health Medicare Advantage	$6.82
Rate for Payer: United Healthcare Commercial	$8.63
Rate for Payer: United Healthcare Medicare Advantage	$6.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.46
Rate for Payer: Wellcare Medicare	$6.14

OSSEOUS/OR OTHER GRAFT OF MAND,AU

Facility

$2,126.00

Service Code	HCPCS D7950
Hospital Charge Code	42302110
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,772.21

OSSEOUS/OR OTHER GRAFT OF MAND,AU

Facility

$2,126.00

Service Code	HCPCS D7950
Hospital Charge Code	42302110
Hospital Revenue Code	361
Min. Negotiated Rate	$1,063.00
Max. Negotiated Rate	$6,907.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,169.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,772.21
Rate for Payer: Aetna Government	$6,772.21
Rate for Payer: Affinity Essential Plan 1&2	$4,740.55
Rate for Payer: Affinity Essential Plan 3&4	$4,740.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,740.55
Rate for Payer: Brighton Health Commercial	$1,594.50
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Cash Price	$6,772.21
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,772.21
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	$6,772.21
Rate for Payer: EmblemHealth Commercial	$6,772.21
Rate for Payer: Fidelis Essential Plan Aliesa	$5,756.38
Rate for Payer: Fidelis Essential Plan QHP	$6,027.27
Rate for Payer: Fidelis Medicare Advantage	$6,772.21
Rate for Payer: Fidelis Qualified Health Plan	$6,027.27
Rate for Payer: Group Health Inc Commercial	$6,772.21
Rate for Payer: Group Health Inc Medicare	$6,772.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,063.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,772.21
Rate for Payer: Healthfirst Medicare Advantage	$5,756.38
Rate for Payer: Healthfirst QHP	$6,772.21
Rate for Payer: Humana Medicare	$6,907.65
Rate for Payer: Senior Whole Health Medicare Advantage	$6,772.21
Rate for Payer: United Healthcare Medicare Advantage	$6,772.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,772.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5,417.77
Rate for Payer: Wellcare Medicare	$6,433.60

OSSEOUS SURGERY INC FLAP ENTRY/CL

Facility

$1,118.41

Service Code	HCPCS D4260
Hospital Charge Code	42300870
Hospital Revenue Code	361
Rate for Payer: Cash Price	$6,772.21

Know your out-of-pocket cost for care.

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